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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206335
Report Date: 07/09/2024
Date Signed: 07/31/2024 10:50:48 AM


Document Has Been Signed on 07/31/2024 10:50 AM - 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 BOARD AND CARE FOR ELDERLYFACILITY NUMBER:
107206335
ADMINISTRATOR:RIGON, RUDYFACILITY TYPE:
740
ADDRESS:3407 N. FRESNOTELEPHONE:
(559) 903-6846
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:6CENSUS: 5DATE:
07/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator (L/A) Rudy Rigon & Assistant Administrator (AA) Aurora RigonTIME COMPLETED:
02:30 PM
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An Annual investigation was conducted by Licensing Program Analyst (LPA) K. McClurg. LPA met with Licensee/Administrator (L/A) Rudy Rigon & Assistant Administrator (AA) Aurora Rigon. LPA greeted L/A & AA, stated purpose of visit & was allowed to proceed with visit.

Physical plant toured. Dining, & living room sufficiently furnished with adequate lighting. Resident bedrooms toured. Resident bathrooms toured. Fixtures operational.

Laundry room toured. Hazardous chemicals &/or cleansers inaccessible. Garage toured. Outside area toured. East side yard observed to have rodent snap-trap set in walkway, next to step-up. Trap removed & made inaccessible @ time of visit. Shed on West side yard observed to have unlocked shed containing gas powered lawn mower & leaf blower. Shed locked @ time of visits making contents inaccessible to clients.

Medications observed to be locked. Centrally stored medication & destruction records reviewed. MARs reviewed. Medication documentation appeared to be in compliance. Interior & exterior passageways observed to be clear of obstructions.

Exit interview conducted with AA. Report provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
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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