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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700702
Report Date: 09/03/2025
Date Signed: 09/03/2025 09:07:09 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/03/2025 09:07 PM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:ROYALTY HOME CAREFACILITY NUMBER:
194700702
ADMINISTRATOR/
DIRECTOR:		DAVIDSON, BINZIE ROYFACILITY TYPE:
300
ADDRESS:23206 LYONS AVE STE 210BTELEPHONE:
(661) 222-9984
CITY:SANTA CLARITASTATE: CAZIP CODE:
91321
CAPACITY: CENSUS: DATE:
09/03/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Dr. Binzie Roy DavidsonTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a Biennial visit. The EA met with the Home Care Organization (HCO) administrator named above.

During the inspection, the EA observed the posting of the license and operating business hours which show the business operates from Monday through Friday, 9AM to 530PM. EA reviewed the personnel records for licensee, staff and Home Care Aides. Furthermore, EA reviewed the HCO’s business records including training agenda, abuse reporting incidents, current designee and insurance requirements.

During today’s visit, EA informed the licensee of the deficiencies found and explained they would be noted on the HCS809-Ds. A copy of this report, HCS809-D for deficiencies and staff records review report were provided to the HCO administrator electronically.
NAME OF LICENSING PROGRAM ANALYST: Joshua Rarela
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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Document Has Been Signed on 09/03/2025 09:07 PM - It Cannot Be Edited


Created By: Joshua Rarela On 09/03/2025 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: ROYALTY HOME CARE
FACILITY NUMBER: 194700702

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/10/2025
Section Cited
1796.43
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(a) Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients. In addition, the home care organization shall do all of the following:
(1) Ensure any staff person, volunteer, or employee of a home care organization who has contact with clients, prospective clients, or confidential client information that may pose a risk to the clients’ health and safety has met the requirements of Sections 1796.23, 1796.24, 1796.25, 1796.26, and 1796.28 before there is contact with clients or prospective clients or access to confidential client information.
(2) Require home care aides to demonstrate that they are free of active tuberculosis disease, pursuant to Section 1796.45.
(3) Immediately notify the department when the home care organization no longer employs an individual as an affiliated home care aide.
(b) This section shall not prevent a licensee from requiring a criminal record clearance of any individual exempt from the requirements of this section, provided that the individual has client contact.
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This requirement is not met as evidenced by: During the review of personnel records, it was observed that staff, Reference #1-#6, did not have their HCA Registry completed, a finding which poses an immediate health and safety risks to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2025
LIC809 (FAS) - (06/04)
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