Above average — CMS composite of the measures below.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at The Royal Home during CMS and state inspections, most recent first.
Failure to Maintain Required RN Coverage: The facility failed to provide an RN for at least 8 consecutive hours a day during multiple days in April, May, and June 2025. PBJ staffing data and timecard review showed no RN hours on those days, and the A-ADM stated the facility had difficulty hiring and retaining a full-time RN/DON, sometimes relied on an LVN to cover the building, and had no RN waiver. An LVN stated an RN is important to assess and provide treatment to residents accurately.
Unqualified Dietary Supervisor: The facility failed to designate a qualified FNS Director to oversee the dietary department. The Dietary Kitchen Supervisor was running daily kitchen operations, supervising staff, creating schedules, and training employees, but stated she was not a certified dietary manager, had not completed her schooling, did not have a degree in food and nutrition, and had not completed an approved dietary service training program. The RD visited monthly and quarterly for menu and diet review, while the A-ADM confirmed the current supervisor did not meet state qualifications.
Opened and undated food items were found in the kitchen condiments area, refrigerator, and freezer, including soy sauce, cooking oil, milk, and frozen vegetables. The DKS confirmed the finding, and the RD stated opened and undated food packages should be discarded because staff would not know when they were opened; the facility policy required all food items to be labeled and dated.
Infection Control Lapses During Feeding and Linen Handling: A CNA did not perform hand hygiene between assisting two residents with feeding, and an uncovered hamper of soiled linens was observed in the clean area of the laundry room. The DON and DSD/IP confirmed that hand hygiene and separation of dirty and clean linen areas are important to prevent the spread of infection, and the residents involved had diagnoses including dementia, schizophrenia, depression, and anemia.
Incomplete POLST Forms for Four Residents: The facility failed to ensure POLST forms were fully completed for four residents. Two residents had POLSTs missing the patient or legal decision-maker's signature, and two residents had POLSTs with the physician's signature but no date; one resident had schizophrenia and Type II DM, another had dementia and chronic venous insufficiency, another had neurogenic bladder, and another had schizophrenia and hyperthyroidism. The DON and SSD confirmed the importance of timely completion of the POLST, and the facility policy stated the POLST is a legally recognized medical order in CA completed by a licensed provider in discussion with the resident or representative.
Feeding Assistance Not Provided at Eye Level: A CNA was observed assisting two residents with meals while standing instead of being seated at eye level. The DON stated staff were expected to be at eye level when rendering care, and the DSD/IP confirmed the importance of feeding residents at eye level. The facility policy stated CNA should be seated at eye level with the resident when possible.
Pureed Diet Served With Lumps: A resident with swallowing difficulty and an order for fortified pureed texture with thin liquids was observed receiving a lunch tray with visible lumps in the food. The DKS, RD, and A-ADM all confirmed that a puree diet should be smooth with no lumps and that the ordered diet should have been followed.
A facility failed to ensure two resident rooms housed no more than the allowed number of residents. Surveyors observed one room with five ambulatory residents and another with eight ambulatory residents, despite privacy screens between beds. The DSD/IP and ADM stated the facility had room waivers but could not produce the approved waiver documentation.
Insufficient Resident Room Space: Surveyors observed three resident rooms that did not meet the minimum 80 sq ft per resident requirement. One room housed 3 ambulatory residents, another housed 5 ambulatory residents, and a third housed 8 ambulatory residents. The DSD/IP and ADM stated the facility had room waivers but could not provide copies of the approved waivers, and instead produced a letter requesting renewal of the room waivers.
Failure to Maintain Required RN Coverage
Penalty
Summary
The facility failed to schedule a Registered Nurse for at least 8 consecutive hours a day during April, May, and June 2025. Review of the Payroll-Based Journal Staffing Data Report showed that the facility had no RN onsite on multiple dates in April, May, and June 2025, and review of the facility’s census, direct care service hours per patient day, and direct care timecard report showed no RN hours recorded on those same dates. The dates without RN coverage included 04/06, 04/11, and 04/13 in April; 05/19 through 05/23 and 05/26 through 05/30 in May; and 06/02 through 06/06, 06/09 through 06/13, 06/16 through 06/20, and 06/23 through 06/30 in June. During interview, the Assistant Administrator stated the facility had issues hiring a regular RN during April, May, and June 2025, had only one RN during that time who could not cover all days, and had difficulty recruiting a full-time RN or DON because of fast turnover and frequent resignations. The Assistant Administrator also stated the facility sometimes relied on an LVN to cover the building and confirmed there was no RN waiver. An LVN stated that having an RN in the building is important to assess and provide treatment to residents accurately. Review of the facility’s undated policy for Director of Nursing and Registered Nurse showed the DON plans, organizes, directs, and controls nursing services, and the RN observes, records, and reports client social, medical, and psychiatric behavior.
Unqualified Dietary Supervisor
Penalty
Summary
The facility failed to designate a qualified Director of Food Services to provide daily oversight of the dietary department, including implementing menus, purchasing food, training staff, and ensuring compliance with state and federal regulations. During interview, the Dietary Kitchen Supervisor stated she was functioning as the Director of Food Services and managing the day-to-day kitchen operations, but she was not a certified dietary manager, had not completed her schooling, did not have a bachelor's degree in food and nutrition, and had not completed an approved dietary service training program required by regulation. The Kitchen Aide stated she reported directly to the Dietary Kitchen Supervisor, who supervised the kitchen, created schedules and assignments, and trained staff on food preparation, serving, and kitchen cleanliness. The Registered Dietitian stated she visited the facility monthly and quarterly to evaluate menus, diets, new admissions, and referred residents, but was unsure whether the Dietary Kitchen Supervisor was licensed or met the qualifications to manage the kitchen. The Assistant Administrator stated the facility previously had a licensed Dietary Kitchen Supervisor, but after that person left in 2022, the current supervisor, formerly the Assistant Dietary Kitchen Supervisor, assumed the role. Review of the facility's undated policy for the FNS Director showed the position must meet state and federal qualifications, and the Assistant Administrator acknowledged the current supervisor did not meet the state qualifications for a dietary supervisor.
Opened and Undated Food Items Found in Kitchen Storage Areas
Penalty
Summary
The facility failed to ensure safe and sanitary food preparation and storage practices in the kitchen when six opened and unlabeled food items were found during an initial observation tour of the kitchen. In the kitchen condiments area, refrigerators, and freezer, the Dietary Kitchen Supervisor found one half-empty gallon of soy sauce, one half-empty gallon of cooking oil, two half-gallons of milk that were more than half empty, and one bag each of frozen cauliflower, frozen mixed vegetables, and frozen green beans, all undated. During interview and record review, the Dietary Kitchen Supervisor confirmed the finding and reviewed the facility's policy titled "Labeling and dating of Foods," which stated that all food items in the storeroom, refrigerator, and freezer need to be labeled and dated, and newly opened food items need to be closed and labeled with an open date and used by the date that follows the storage guidelines. The Registered Dietitian stated that opened and undated food packages should be thrown away because staff would not know when they were opened, and that dietary staff were expected to follow infection control precautions for food safety.
Infection Control Lapses During Feeding and Linen Handling
Penalty
Summary
The facility failed to implement infection control and prevention measures when a CNA did not perform hand hygiene between assisting two residents with feeding during dining observation. On 9/23/25 at 11:56 AM, CNA 2 was observed assisting Residents 7 and 18 simultaneously at the same table without washing hands in between providing feeding assistance. During an interview later that day, CNA 2 stated that handwashing between assisting residents was important to prevent cross contamination. The DON and the DSD/IP also confirmed that hand hygiene is important to prevent the spread of infection and to break the chain of infection. Resident 7’s face sheet listed diagnoses including dementia and schizophrenia, and Resident 18’s face sheet listed diagnoses including depression and anemia. The facility also failed to keep soiled linen separated from the clean area in the laundry room. During a tour of the laundry area on 9/24/25 at 11:46 AM, an uncovered hamper containing soiled fitted sheets and flat sheets was observed beneath the clean area countertop. CNA 1 verified that the hamper contained soiled linens. The DSD/IP stated that dirty linens should not be placed in the clean area of the laundry room to break the chain of infection, and the DON stated that the laundry room should separate dirty linens from the clean area to prevent the spread of infection. The facility’s policy on linen handling stated that soiled linen hampers should always be kept covered and linen neatly inside.
Incomplete POLST Forms for Four Residents
Penalty
Summary
The facility failed to ensure Physician Orders for Life Sustaining Treatment (POLST) forms were completed for four sampled residents. Resident 1, who had diagnoses including schizophrenia and Type II diabetes mellitus, had a POLST form in which Section D contained the physician's signature without a date and was missing the patient or legal decision-maker's signature. Resident 4, who had diagnoses including dementia and chronic venous insufficiency, had a POLST form with the physician's signature but no patient or legal decision-maker's signature. Resident 12, who had neurogenic bladder, had a POLST form in Section D with the physician's signature without a date and no patient or legal decision-maker's signature. Resident 19, who had diagnoses including schizophrenia and hyperthyroidism, had a POLST form with the physician's signature but was missing the patient or legal decision-maker's signature. During interview, the DON and SSD confirmed the importance of timely signing and completing the POLST to ensure accurate care for residents in the event of an emergency. The facility policy stated that the POLST is a legally recognized medical order in California and must be completed by a licensed healthcare provider in discussion with the resident or their representative.
Feeding Assistance Not Provided at Eye Level
Penalty
Summary
The facility failed to promote independence and dignity for two residents when CNA 2 assisted them with feeding while standing instead of being seated at eye level. During dining observation on 9/23/25 at 11:56 AM, CNA 2 was observed helping Residents 7 and 18 simultaneously as they sat across from each other at the same table, and CNA 2 remained standing while assisting both residents with their meals. During an interview on 9/23/25 at 12:28 PM, CNA 2 stated that residents might not finish their meals when assisted in a sitting position. Resident 7's face sheet showed diagnoses of dementia and schizophrenia, and Resident 18's face sheet showed diagnoses of depression and anemia. During interviews on 9/25/25, the DON stated that staff were expected to be at eye level with residents when rendering care, and the DSD/IP confirmed the importance of feeding residents at eye level, stating, "You don't need to show to residents that you're above them." The facility's undated Feeding Assistance Policy and Procedure stated that CNA should be seated at eye level with the resident when possible.
Pureed Diet Served With Lumps
Penalty
Summary
The facility failed to prepare food in a form designed to meet the needs of one resident who was ordered a fortified pureed texture diet with thin liquids. During an observation in the dining room, the resident’s lunch tray contained chicken barbeque, seasoned potato, and corn with notable lumps present, even though the diet ticket stated fortified puree. The Dietary Kitchen Supervisor stated that the resident’s diet order was puree and that the meal should have had a smooth texture with no lumps. A review of the physician orders showed a fortified pureed texture with thin liquids, and the Registered Dietitian’s quarterly review noted that the resident had swallowing difficulty and was on a fortified pureed texture diet. The RD stated that a puree diet is expected to be smooth like pudding with no lumps for safe swallowing and confirmed that the diet order should have been followed. The Assistant Administrator also reviewed the facility’s menu planning policy, which stated that the facility’s diet manual and physician-ordered diets should mirror the nutritional care provided, and stated that staff should have followed the policy.
Excessive Residents in Shared Rooms Without Available Waiver Documentation
Penalty
Summary
The facility failed to ensure that two resident rooms accommodated no more than four residents. During an initial tour on 9/23/25 at 9:28 AM, surveyors observed one room occupied by five ambulatory residents and another room occupied by eight ambulatory residents, with mobile privacy screens placed between beds in both rooms. The room with five residents included Residents 2, 4, 11, 13, and 14, and the room with eight residents included Residents 1, 5, 7, 12, 15, 16, 17, and 19. During interviews, the DSD/IP stated on 9/24/25 at 5:48 PM that the facility had room waivers but could not provide a copy of the approved room waiver, and the Administrator stated on 9/25/25 at 11:28 AM that the facility had lost the copy of the approved room waivers. The facility was not able to provide a copy of the approved room variance waivers.
Insufficient Resident Room Space
Penalty
Summary
The facility failed to meet the minimum requirement of 80 square feet per resident in three of five resident rooms. During an initial tour on 9/23/25 at 9:28 AM, surveyors observed that room [ROOM NUMBER] was occupied by three residents, room [ROOM NUMBER] had five residents, and room [ROOM NUMBER] had eight residents, and all residents in the three rooms were ambulatory. During an interview on 9/24/25 at 5:48 PM, the DSD/IP stated that the facility had room waivers but was not able to provide a copy of the approved room waivers, and instead provided a letter requesting renewal of room waivers dated 9/24/25. The letter indicated that room [ROOM NUMBER] measured 238 square feet for three residents, room [ROOM NUMBER] measured 352.63 square feet for five residents, and room [ROOM NUMBER] measured 631.95 square feet for eight residents, with allocated space per resident of 79.33, 70.52, and 78.99 square feet, respectively. During an interview on 9/25/25 at 11:28 AM, the Administrator stated that the facility lost the copy of the approved room waivers and was not able to provide a copy of the approved room variance waivers.
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What surveyors actually found near you
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near El Cajon
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Country Hills Post Acute | 1.1 mi | ★★★★★ | 9 | 1 |
| Cottonwood Canyon Healthcare Center | 1.8 mi | ★★★★★ | 7 | 0 |
| Granite Hills Healthcare & Wellness Centre, Llc | 1.8 mi | ★★★★★ | 1 | 0 |
| Bradley Court | 1.8 mi | ★★★★★ | 0 | 0 |
| Lakeside Special Care Center | 2.3 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.