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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005985
Report Date: 07/01/2021
Date Signed: 07/02/2021 09:09:18 AM

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 CARE FAMILY HOMESFACILITY NUMBER:
306005985
ADMINISTRATOR:ASIS, EMELYNFACILITY TYPE:
740
ADDRESS:506 N. ROYAL ST.TELEPHONE:
(562) 461-9820
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY:6CENSUS: 3DATE:
07/01/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Emelyn AsisTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Lydia Martinez made an announced visit for the purpose of conducting a Pre-licensing evaluation. LPA Martinez met with Applicant Emelyn Asis and reason for visit was discussed. Facility is an existing facility and undergoing a Change of Ownership. Currently there are three (3) residents in the facility. Facility will continue to operate as an Residential Care For the Elderly (RCFE), capacity for 6 residents of which 2 may be non-ambulatory. LPA observed the following: Facility is a 6 bedroom, 2 bathroom, single story house with a detached garage. There is no access into garage from inside the home. There is a patio cover and seating for all residents. There are two side gates that lead to the backyard. Facility telephone number is (714) 630-3212. The resident bedrooms are spacious and furnished. Bathrooms were clean, faucets and toilets were operational. Linens & hygiene supplies were observed. Applicant is aware of the need for 7 days non-perishable food and 2 day perishable at all times while residents are present. Smoke and Carbon Monoxide detectors are wireless interconnect, were tested and were found to be operational. Fire Extinguishers were observed and mounted. Stove burners, microwave, washer, and dryer inspected. Locked/stored area for knives under kitchen sink. Toxins will be kept in locked garage and some locked under kitchen sink. Hot water temperature is tested and is within regulatory requirements.. Medication will be kept in locked cabinet in dining room. First-Aid Kit & Activity Supplies were observed and available. Applicant is aware of the required documentation/training for residents and staff per regulation. Fire clearance was approved on 04/21/2021. A Component III Orientation was conducted during this Pre-Licensing visit. Applicant demonstrated a clear, concise and comprehensive knowledge of medication protocols, documentation and preventative protocols.

During walk through of the facility, LPA noted a room was added inside the garage. Current facility staff stated room was built/added in 2020. Room is not on approved Facility Sketch (floor plan) that was cleared by Anaheim Fire Department. A voicemail message was left for Inspector Alicia Badosa to clarify before facility can be licensed.


This report was reviewed with the Applicant and a copy was provided.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
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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