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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003568
Report Date: 01/05/2022
Date Signed: 01/05/2022 01:41:07 PM

Document Has Been Signed on 01/05/2022 01:41 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ROYALE BEST CARE HOMEFACILITY NUMBER:
306003568
ADMINISTRATOR:LEILANI & NOLAN ALEJANDROFACILITY TYPE:
735
ADDRESS:12051 GILBERT STREETTELEPHONE:
(714) 530-8181
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 6CENSUS: 4DATE:
01/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Leilani AlejandroTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Leilani Alejandro and stated the purpose of this visit.

The facility is a single level structure and licensed for six ambulatory of which two may be non-ambulatory .

About 10:30 AM , LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, there were four clients in care and three staff members on the floor. LPA toured the interior and exterior portions of the facility. There were two private and one client’s rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide alarms were tested to be operational. Bathrooms were observed to be in good repair; and provided with handrails and nonskid-floor mat. Hot water was measured at 105 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to clients in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had outside furniture in good repair. Grounds were free of tripping hazards. LPA Marin reviewed the COVID 19 mitigation plan of the facility.

LPA Marin offered assistance to AD Alejandro regarding the Guardian System.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

LPA Marin conducted an exit interview with AD Alejandro and copy of this report was left in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2022
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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