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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203215
Report Date: 04/11/2022
Date Signed: 04/11/2022 01:31:37 PM


Document Has Been Signed on 04/11/2022 01:31 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, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:ROYAL CAREFACILITY NUMBER:
107203215
ADMINISTRATOR:RIGON, RUDY G.FACILITY TYPE:
740
ADDRESS:2768 PURVIS AVE.TELEPHONE:
(559) 324-8792
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 3DATE:
04/11/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Caregiver, Modesta PazTIME COMPLETED:
01:45 PM
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On 04/11/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an POC inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator is not available during this inspection. LPA spoke with Administrator Aurora Rigon via telephone. LPA received verbal permission to meet with Caregiver, Modesta Paz.

The purpose of this visit is to follow up on a citation that was issued on 02/28/2022. As of 04/11/2022, Administrator has not submitted a written statement detailing the steps the facility will take to ensure that the facility will maintain accurate records for cash resources.

LPA discussed the Plan of Correction with Administrator.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Caregiver, Modesta Paz, whose signature on this form confirms receipt of this document.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2022
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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