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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003568
Report Date: 01/11/2024
Date Signed: 01/11/2024 04:18:26 PM

Document Has Been Signed on 01/11/2024 04:18 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: 3DATE:
01/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Leilani Alejandro- Administrator
Marife Dumlao- Assistant Administrator		TIME COMPLETED:
04:35 PM
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Licensing Program Analysts (LPAs) Jessica Cho and Sean Haddad arrived unannounced for the purpose to conduct the Required 1-Year Annual Inspection. LPAs were greeted and granted entry after stating the purpose of the visit to Assistant Administrator (AA) Marife Dumlao. Administrator (Admin) Leilani Alejandro arrived on site to assist with the inspection.

LPAs conducted a tour of the indoor/outdoor area of the facility accompanied by the Admin and AA. The following was observed: This is a single story facility comprised of four bedrooms and three bathrooms. LPAs observed two additional bedrooms and one additional bathroom inside the facility and are pending clearance. There is a backyard with a patio cover for shading. LPAs observed one client and one staff present at the facility. The three client bedrooms are spacious and easily accommodates the clients' furnishings. Furniture for each client bedrooms were inspected. LPAs inspected the staff bedroom as well. The bathrooms were clean, faucets, and toilets were operational. The hot water temperature reading was initially measured at 132 .0 and 142.0 degrees Fahrenheit and was readjusted/corrected during the visit which then measured at 119.0 and 117.0 degrees Fahrenheit for two out of the two client bathrooms. There was sufficient supply of clean linens. LPAs observed a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Carbon monoxide, smoke detectors, fire extinguisher were tested and in operating condition. LPAs observed medications were centrally stored and secured. Facility's licensing fees are paid. LPAs reviewed the three client files and two staff files, interviewed one client and one staff. LPAs inspected the funds and ledgers for the three clients.

Based on the observations made during today’s inspection, a deficiency is being cited per the Title 22 Division 6 of the California Code of Regulations. See LIC809D.

An exit interview was conducted and a copy of this report and appeal rights were discussed with and provided to Administrator Leilani Alejandro and Assistant Administrator Marife Dumlao.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
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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Document Has Been Signed on 01/11/2024 04:18 PM - It Cannot Be Edited


Created By: Jessica Cho On 01/11/2024 at 03:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ROYALE BEST CARE HOME
FACILITY NUMBER: 306003568

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs' observations, the hot water temperature reading tested at 132.0 and 142.0 degrees Fahrenheit in two out of the three bathrooms used by clients which poses an immediate safety risk to persons in care.
POC Due Date: 01/12/2024
Plan of Correction
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During the inspection, the licensee adjusted the water temperature which was confirmed by LPA Haddad and licensee stated that they will check the water temperature to ensure that it's within a comfortable range in addition to a written log. This deficiency was cleared during the visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Jessica Cho
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024


LIC809 (FAS) - (06/04)
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