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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167209247
Report Date: 02/01/2023
Date Signed: 02/01/2023 11:42:15 AM


Document Has Been Signed on 02/01/2023 11:42 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:ROYAL PARENTS HOME CAREFACILITY NUMBER:
167209247
ADMINISTRATOR:ROY, CHURCHILLFACILITY TYPE:
740
ADDRESS:1980 WEST RIO HONDO WAYTELEPHONE:
(909) 571-9489
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:6CENSUS: 0DATE:
02/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Licensee Roy ChurchillTIME COMPLETED:
12:00 PM
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On 2/01/2023, Licensing Program Analyst (LPA) K. Kaur arrived at the above facility to conduct a case management - closure inspection. The purpose of the inspection is for a voluntary closure. LPA introduced self, stated the purpose of the visit, and met with Licensee Roy Churchill

LPA conducted a final tour with Licensee and observed no residents at the facility. Licensee informed LPA no residents were placed at the facility. Licensee surrendered RCFE license. Closure inspection is complete.



No deficiencies issued.

An exit interview was conducted with Licensee. Report signed on site and printed copy provided. Facility closure will be processed upon LPA’s return to the office.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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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