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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004311
Report Date: 11/28/2022
Date Signed: 11/28/2022 03:08:23 PM


Document Has Been Signed on 11/28/2022 03:08 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:ROYAL LIVINGFACILITY NUMBER:
306004311
ADMINISTRATOR:ELENA CECILIA MARINESCUFACILITY TYPE:
740
ADDRESS:18601 PATRICIAN DRIVETELEPHONE:
(714) 998-7098
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY:3CENSUS: 0DATE:
11/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Mitch MarinescuTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of case management visit to close the facility. LPA was greeted and granted entry into the facility and explained the reason for the visit.
LPA received written notification on 11/01/2022 from Licensee for intent to close the facility. Facility has not had any residents admitted since approximately 2020.

During the visit, LPA toured the facility and observed no clients residing in the facility. Licensee was provided with department forfeiture of license letter. Licensee surrendered facility license to LPA.











Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2022
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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