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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006277
Report Date: 05/22/2023
Date Signed: 05/22/2023 10:35:44 AM


Document Has Been Signed on 05/22/2023 10:35 AM - 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 RCFEFACILITY NUMBER:
306006277
ADMINISTRATOR:NORMAN, WILMAFACILITY TYPE:
740
ADDRESS:2547 E. NORM PLACETELEPHONE:
(714) 655-7970
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY:6CENSUS: 2DATE:
05/22/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Renee FuehrerTIME COMPLETED:
10:50 AM
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Licensing Program Analysts (LPAs) Dwayne Mason Jr. and Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPAs met with Applicant (AP) Renee Fuehrer, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 11/17/2022. This is a change of ownership with persons in care.

During the inspection, LPAs and AP observed the following: Structure. This is a one-story home. Facility is a 7-bedroom, 3-bathroom, 1 story house with attached garage that is being used for storage. There is a back yard with a patio cover for the residents. Facility telephone number is (714) 844-2282. Resident Bedrooms. The 6 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lights, chairs, linens, and storage for each resident bedroom inspected. Staff Bedrooms. There is one staff bedroom. Bathrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 111.7 and 118.4 F degrees. Linens & Hygiene Supplies. New linens and fully stocked linen closet observed. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Food Service. 2 days perishable and 7 days nonperishable food supply reviewed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detectors/carbon monoxide detectors. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen drawer. Toxins: observed locked under the kitchen. Medication closet is locked. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files. LPA reviewed 2 resident and 2 staff files. Fire clearance was approved by Orange County Fire Authority on 04/04/2023. Backyard. Backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. Facility is currently operating under the liability insurance of current facility ROYAL RCFE (306004632). AP will switch liability insurance to new facility once the application is approved.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROYAL RCFE
FACILITY NUMBER: 306006277
VISIT DATE: 05/22/2023
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During the inspection, LPAs and AP observed the following: the fire clearance states the facility has an ambulatory capacity of 5, a non-ambulatory capacity of 0, and a bedridden capacity of 1. Based on review of resident files, 2 out of 2 residents are non-ambulatory. AP stated they will work with the fire inspector and CAB to update the fire clearance for as many non-ambulatory rooms as possible and notify LPA once the facility is ready for inspection.

During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed the items listed above must be completed for the facility to meet Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to AP.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
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