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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197606562
Report Date:
12/01/2021
Date Signed:
12/01/2021 01:11:30 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
ROYALTY GUEST HOME, INC.
FACILITY NUMBER:
197606562
ADMINISTRATOR:
ELENA ANGUSTIA
FACILITY TYPE:
740
ADDRESS:
20609 BRYANT STREET
TELEPHONE:
(818) 727-1741
CITY:
CANOGA PARK
STATE:
CA
ZIP CODE:
91306
CAPACITY:
6
CENSUS:
DATE:
12/01/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Elena Angustia
TIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced case management visit to this facility. LPA met with the administrator and explained the reason for this visit.
LPA conducted this visit to gather information related to a possible pest control issue that was brought to the attention of the LPA.
LPA conducted a physical plant walk through of the facility to ensure no immediate health and safety issues. LPA checked resident bedrooms and bathrooms. LPA spoke with the administrator regarding the issue. Administrator stated that the pest control company will be coming to the facility in the month of December and she will contact them to see if they will come as soon as possible. LPA also discussed the plan the administrator has for the facility to ensure that the pest control issue can be remedied as soon as possible.
Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/01/2021
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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