306006148-8-24-2026-22-AS-TSIY-DX5US3-20260820154939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006148
Report Date: 08/20/2026
Date Signed: 08/24/2026 12:42:18 PM

Document Has Been Signed on 08/24/2026 12:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	GRAND VIEW VILLAS INC.		FACILITY NUMBER:	306006148
ADMINISTRATOR/ DIRECTOR:	AMLANI, ROZINA		FACILITY TYPE:	740
ADDRESS:	25262 VIA DE ANZA		TELEPHONE:	(714) 348-4793
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY: 6		CENSUS: 6	DATE:	08/20/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:45 PM
MET WITH:	Rozina Amlani, Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Kimberly Lyman and Taylor Simerly conducted an unannounced visit to Grand View Villas Inc. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs were allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, of which one may be bedridden. Facility has an approved hospice waiver for five residents and there was one resident on hospice care today. Administrator Rozina Amlani has an administrator certificate valid until August 28, 2026 and is waiting for her updated certificate. The facility has valid liability insurance through May 13, 2027. Upon entry, facility appears clean, safe and sanitary. LPAs toured the facility along with Administrator. LPAs toured the physical plant, checked food service, first aid kit and reviewed records. Facility is a one story home with 7 bedrooms (1 for staff), 7 bathrooms, living room, family room, dining room, kitchen, and an attached 2 car garage with laundry machines. The garage is kept locked and used for storage. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPAs observed two residents with half bed rails and one resident with full rails. Resident restrooms were checked. LPAs observed that the water was returned off in R5s restroom. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 113.3 and 115.5 degrees F in all facility restrooms. Resident toiletries and personal hygiene supplies were adequately stocked at time of visit. R2s bathroom did not have a cover on the overhead bathroom light and fan. Common areas were clean and clear of hazards, doorways were free of obstructions. LPAs observed the first aid kit with all the elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher is fully charged. The outside grounds were toured and there is ample shaded seating for residents. LPAs observed a fountain in the backyard. Exit gates are unlocked and operational. CONTINUED ON LIC 9099C DATED August 20, 2026.

Alfonso Iniguez
Taylor Simerly
	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GRAND VIEW VILLAS INC.	FACILITY NUMBER: 306006148
	VISIT DATE: 08/20/2026

NARRATIVE

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Emergency food was observed. The emergency disaster plan was reviewed during the visit. Facility provided documentation of last fire drill conducted on July 10, 2026 and drills are conducted quarterly. Facility provides activities in the form of exercise, games and music. LPAs reviewed resident and staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Staff files reviewed contained required documentation of medical clearance, training and criminal record clearance. LPAs reviewed medication storage and administration. Medications are stored in a locked cabinet. LPAs observed staff are taking blood pressure for two residents with parameter medication orders. None of the staff are skilled professionals. Medications appear to be administered per physician order.

Licensee to forward an updated LIC 500 and LIC 308 to LPA by close of business on September 3, 2026.

Based on the observations made during today's visit, deficiencies are being cited per Title 22 division 6 of the California Code of Regulations. An exit interviewed was conducted and a copy of the report along with appeal rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Alfonso Iniguez
NAME OF LICENSING PROGRAM ANALYST: Taylor Simerly
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/24/2026 12:42 PM - It Cannot Be Edited

Created By: Taylor Simerly On 08/20/2026 at 03:10 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GRAND VIEW VILLAS INC.	FACILITY NUMBER: 306006148
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(a)

Maintenance and Operation

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in. LPAs observed R2s bathroom light/ fan did not have a cover and R5s water was turned off in bathroom which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/03/2026
	Plan of Correction
1 2 3 4	Licensee to repair/ replace noted items and forward proof to LPA by POC due date.

Type B

Section Cited

CCR

87608(a)(3)

Postural Supports

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in LPAs observed R6s had full bed rails without a physician order in which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/03/2026
	Plan of Correction
1 2 3 4	Licensee will forward proof of physicians order to LPA by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Alfonso Iniguez
NAME OF LICENSING PROGRAM MANAGER:

	Taylor Simerly
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/24/2026 12:42 PM - It Cannot Be Edited

Created By: Taylor Simerly On 08/20/2026 at 03:22 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GRAND VIEW VILLAS INC.	FACILITY NUMBER: 306006148
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87411(h)

This requirement is not met as evidenced by: (h) All services requiring specialized skills shall be performed by personnel qualified by training or experience in accordance with recognized professional standards.
	Deficient Practice Statement
1 2 3 4	Based on observation and record review the licensee did not comply with the section cited above in which two out of six residents have parameter medication that are being administered by non licensed staff which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/21/2026
	Plan of Correction
1 2 3 4	Licensee will obtain updated physician orders for two residents and send proof to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Alfonso Iniguez
NAME OF LICENSING PROGRAM MANAGER:

	Taylor Simerly
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

LIC809 (FAS) - (06/04)

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