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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003568
Report Date: 02/21/2023
Date Signed: 02/21/2023 04:23:38 PM

Document Has Been Signed on 02/21/2023 04:23 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
ORANGE & INLAND A/SC, 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: 3DATE:
02/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Leilani Alejandro, AdministratorTIME COMPLETED:
05:00 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted a case management visit in relation to the facility visit dedicated to delivering findings in the investigation of complaint 22-AS-20230131073452.

No death reports following the passing of client C1 were addressed to the Department as required by the California Code of Regulations Section 80061(b)(1)(B) Reporting Requirements.

LPA requested that licensee provide a copy of client C1's death certificate no later than February 28, 2023.

One Technical Advisory is issued today regarding Death Reporting Requirements.

An exit interview was conducted and a copy of the report along were provided to facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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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