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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005689
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:32:40 PM


Document Has Been Signed on 06/13/2024 01:32 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:John Paul PamintuanTIME COMPLETED:
12:45 PM
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On 6/13/2024, Licensing Program Analyst (LPA) Cassie Yang and Department of Consumer Affairs Associate Governmental Program Analyst (AGPA) Jordan McLaughlin arrived unannounced at the facility to conduct a required annual inspection utilizing the care tool. LPA met with caregivers, and explained the purpose of the visit. Caregiver then contacted Administrator who arrived to the facility shortly afterwards.

During today's visit, LPA, AGPA and Administrator conducted a tour of the interior and exterior of the facility. LPA informed Administrator that gardening tool are to be stored immediately after usage. LPA informed Administrator that staff room is to be closed and locked at all times as chemical are stored in staff area, during time of visit, staff was observed present in the room.

LPA observed medications to be locked, LPA reminded Administrator that key to locked cabinet is to be inaccessible to residents in care. LPA observed sharps and toxins to be locked under the sink. LPA observed the presence of 2+ days of perishable and 7+ days of non-perishable food. LPA observed fire extinguisher presence.

File review conducted for three personnel and six residents. LPA informed Administrator that residents with dementia are to be medically assessed annually. LPA and Administrator discussed annual staff training of 20 hours.

No deficiencies cited during this visit.

Exit interview and a copy of the report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024
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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