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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005689
Report Date: 06/16/2022
Date Signed: 06/16/2022 01:40:40 PM


Document Has Been Signed on 06/16/2022 01:40 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:CHATEAU ROYALE CAREFACILITY NUMBER:
347005689
ADMINISTRATOR:PAMINTUAN, JOHN PAULFACILITY TYPE:
740
ADDRESS:2745 CALIFORNIA AVETELEPHONE:
(916) 365-7994
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Marco GomezTIME COMPLETED:
01:50 PM
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On 06/16/2022 at 12:30 pm, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced to conduct a Required 1 Year inspection. LPA met with caregiver, Cadine Jackson, who contacted Administrator, Marco Gomez , who arrived to the facility shortly afterwards. LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and was requested to do so also upon entering the facility. Staff observed LPA's temperature to be 99.3* and screened LPA for other COVID-19 symptoms. LPA was asked to not enter the community until her temperature decreased to assure the health and safety of the residents. The following Personal Protective Equipment (PPE) was worn: surgical mask.

LPA and Administrator toured and observed the facility to ensure the health and safety of residents in care. Areas toured include, but are not limited to: common areas,(2) private bedrooms, private bath, dining room, laundry area and kitchen. LPA advised Administrator to post a "Mask Required" sign at the front door for visitors. LPA observed 2+day perishable and 7+day non-perishable food supply. PPE supplies for 30+days on hand. LPA observed locked toxins, medications and sharps. LPA observed fire extinguishers to be up to date, last serviced on 01/02/2022. LPA observed the facility to have documentation of staff and residents temperature and daily screenings. LPA observed the Administrator Certificate #6045884740 to be up to date, expiration of 01/08/2024. In the areas toured, there were no immediate health, safety, or personal rights violations observed. LPA and Administrator completed the infection control domain and facility was found to be in compliance at this time.

LPA requested Administrator to send a copy of the Liability insurance via email by 6/23/2022.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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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