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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200082
Report Date: 05/02/2023
Date Signed: 05/02/2023 04:29:21 PM

Document Has Been Signed on 05/02/2023 04:29 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:ALEGRE, FELIX JAMESFACILITY TYPE:
735
ADDRESS:1606 ALCATRAZ AVE.TELEPHONE:
(510) 655-8221
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY: 32CENSUS: 26DATE:
05/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Felix James Alegre, Manager/AdministratorTIME COMPLETED:
04:30 PM
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On 05/02/23 at 01:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct annual inspection visit. LPA met with Felix James Alegre, Manager/Administrator (ADM), and explained the purpose of the visit. Licensee currently holds a certificate (#6002772725) that expires 06/11/23. The facility’s fire clearance was approved for thirty-two (32) clients; four (4) may be non-ambulatory.

Upon arrival LPA observed two (2) staff attending to residents and monitoring the facility. LPA and ADM toured the facility including, but not limited to the bathroom, kitchen, common areas, dining area and courtyard. The facility consists of individual units housed by clients with proper furniture, window coverings, and lighting. All outdoor and indoor passageways were free of obstruction. There were no bodies of water. A comfortable temperature was maintained at 71 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the clients. Hot water temperature in the shared residents' bathroom was measured at 110.3 degrees (F). All toilets, hand washing, and bathing areas were safe, sanitary and in operating condition. Hand washing signs, paper towels, and soap observed at all hand washing stations. Linen and hygiene products were available for all clients. PPE, sanitizer, and paper goods remain sufficient.



...continued on LIC9099C.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/02/2023
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...continued from LIC9099.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was observed full and new tag to be replaced on 05/09/2023. Emergency Disaster Plan is updated. Safety drill was last conducted 03/2023 and are rotational between AM and PM schedules monthly.

Five (5) staff records were reviewed, and all staff have criminal record clearances. Five (5) residents records were reviewed and complete.

Exit interview conducted and a copy of this report provided to ADM.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
LIC809 (FAS) - (06/04)
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