019200082-5-17-2023-15-AS-YFLS-CRXP73-20230518110316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200082
Report Date: 05/17/2023
Date Signed: 05/17/2023 09:47:07 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/21/2023 and conducted by Evaluator Lisha Holmes

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230321111412

FACILITY NAME:	ROYAL COLONY IN BERKELEY		FACILITY NUMBER:	019200082
ADMINISTRATOR:	ALEGRE, FELIX JAMES		FACILITY TYPE:	735
ADDRESS:	1606 ALCATRAZ AVE.		TELEPHONE:	(510) 655-8221
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94703
CAPACITY:	32	CENSUS: 26	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Felix James Alegre, Manager		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility heater is in disrepair
Facility hot water plumbing is in disrepair
Staff leave refrigerated foods out on the counter
Facility has roaches

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 05/17/23 at 9:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint findings for the above allegations. LPA met with Staff #1 (S1) and explained the purpose of the visit.

Allegations:
Facility heater is in disrepair
Facility hot water plumbing is in disrepair
Staff leave refrigerated foods out on the counter
Facility has roaches

The above allegations are UNSUBSTANTIATED.
Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 15-AS-20230321111412

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 BERKELEY	FACILITY NUMBER: 019200082
	VISIT DATE: 05/17/2023

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
26
27
28
29
30
31
32

...continued from LIC9099

During the course of the investigation, LPA interviewed six (6) Clients, two (2) Care Staff and one (1) Witness. LPA requested the following documents: Commercial pest agreement and receipts for 01/2023 to 03/2023. LPA toured facility's dining room, kitchen area, and bedrooms and requested Clients (C5, C6) ID/Emergency contact information, and appraisal/needs and services plan.

LPA and S1 toured room #15, across the hallway from room #10, that was under construction for plumbing repairs; a construction crew was on site during the complaint investigation on 03/30/23. Two other bathrooms were available for all clients, in good repair and the water temperature tested at 110.3 Fahrenheit (F). LPA further observed breakfast, lunch, and dinner menus posted in the dining area, serving times were visible for clients. S1 and S2 said snacks are always available. The facility's food and dining practices consist of prepping the dishes, cups, flatware, and beverages so that all the clients can eat at the same time. If the food is frozen, it is defrosted in hot water and prepared after defrosted. The kitchen and dining area were clean and in good repair. S1 and S2 appeared to exercise safe and proper food handling while preparing meals during the investigation and inspections on 03/30/23 and 05/02/23.

Continued on LIC9099C...

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20230321111412

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 BERKELEY	FACILITY NUMBER: 019200082
	VISIT DATE: 05/17/2023

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
26
27
28
29
30
31
32

...continued from LIC9099C

LPA reviewed Advanced IPM pest control service summaries for February and March 2023, pest control invoices for January and February 2023, and reviewed a sample of reports dating back to May 2022. C6 did not answer the door at room #10 or respond while LPA and S1 knocked on the room door while at the facility. LPA interviewed C5 at room #11 who stated that he/she does not have any pest in the room, there had been bed bugs in the past but the was cleared and there had been a rat in the backyard that maybe came from next door. LPA did not observe any pest or roaches during the visit. Interviews with Clients (C1, C2, C3, C4, C5) and S1 revealed that there was no longer a presence of roaches in or around the room(s). Advanced IPM pest control visit on 03/16/23 had already addressed the allegation of the presence of roaches by gel bait to mitigate the spread. C6 was recommended to remove garbage and maintain sanitation in room #10. Invoices showed that Advanced IPM is contracted monthly and is available to address specific pest issues that may arise; facility will continue to inspect for pest and encourage the clients to monitor their garbage in their units.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of this report provided to Felix James Alegre, Manager.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3