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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607169
Report Date: 10/26/2022
Date Signed: 10/26/2022 02:39:59 PM

Document Has Been Signed on 10/26/2022 02:39 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:REGAL HOME CARE CORPORATIONFACILITY NUMBER:
197607169
ADMINISTRATOR:LOIDA V. QUIJANOFACILITY TYPE:
735
ADDRESS:20746 COMMUNITY STREETTELEPHONE:
(818) 998-0477
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 4CENSUS: 3DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Teresita AusanTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Teresita Ausan and explained the reason for the visit.

At approximately 11:20am, with the assistance of staff, LPA took a tour of the physical plant. The smoke alarms are battery operated. The carbon monoxide detector functions properly. There is a fully charged located in the kitchen.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets.

Bedrooms: There were three (3) bedrooms designated for residents' use, and one (1) bedroom designated for staff. The three bedrooms, in use by residents, were were properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 120 degrees Fahrenheit. No cleaning supplies or toxins were stored underneath the kitchen or medicine cabinet. Cleaning supplies and detergents are kept in the locked garage.

Common Areas: These included the living room and dining area. The common areas was observed to be properly furnished. Furniture was in good repair. Floors were clean and sanitary. The passageways to the front and back yards were free of obstruction.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: REGAL HOME CARE CORPORATION
FACILITY NUMBER: 197607169
VISIT DATE: 10/26/2022
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Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. The laundry area is located by the entrance, adjacent to the garage. Cleaning supplies and detergents are kept in the locked garage.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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