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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200082
Report Date: 11/04/2024
Date Signed: 11/04/2024 02:29:39 PM

Document Has Been Signed on 11/04/2024 02:29 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ROYAL COLONY IN BERKELEYFACILITY NUMBER:
019200082
ADMINISTRATOR/
DIRECTOR:		ALEGRE, FELIX JAMESFACILITY TYPE:
735
ADDRESS:1606 ALCATRAZ AVE.TELEPHONE:
(510) 655-8221
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY: 32CENSUS: 21DATE:
11/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:James Alegre, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 11/04/2024 around 12:50 PM, L. Holmes, Licensing Program Analysts (LPA) arrived unannounced to deliver the complaint findings for 15-AS-20240731102818. LPA met with James Alegre, Administrator (ADM) and explained the purpose for conducting a case management.

Based on interviews and records reviewed, the licensee did not comply with Title 22 by not coordinating with C1’s case manager to arrange for transportation for medical services or allowing ADM to transport Clients. Licensee instructs ADM to contact S1, 911 for emergency care and relies on the Case Managers to provide transportation.



The following deficiency is cited on LIC 809D from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted, appeal rights and a copy of this report was provided to James Alegre, Administrator (ADM)
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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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Document Has Been Signed on 11/04/2024 02:29 PM - It Cannot Be Edited


Created By: Lisha Holmes On 11/04/2024 at 02:04 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
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ROYAL COLONY IN BERKELEY
FACILITY NUMBER: 019200082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2024
Section Cited
CCR
85064(j)(6)(A)

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85064 Administrator Qualifications and Duties (j) The administrator shall perform the following duties: (6) Arrangement for the clients to attend available community programs, when clients have needs, identified in the needs and services plan, which cannot be met by the facility but can be met by community programs. (A)Such arrangements shall include, but not be limited to, arranging for transportation.
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Licensee to develop and implement a plan to ensure that all Clients have resources for transportation to seek preventative health care, emergency services, and community-based programs. Licensee to submit the plan to CCLD on or before the POC date with proof of attendees’ signatures.
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-This requirement is not met as evidenced by:
Based on interviews, the licensee did not comply with the section cited above by not coordinating with C1’s case manager to arrange for medical transportation which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Lisha Holmes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


LIC809 (FAS) - (06/04)
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