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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603741
Report Date: 04/25/2024
Date Signed: 06/13/2024 09:26:21 AM

Document Has Been Signed on 06/13/2024 09:26 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ROYER ARFFACILITY NUMBER:
374603741
ADMINISTRATOR/
DIRECTOR:
ROYER, TAMARAFACILITY TYPE:
735
ADDRESS:2598 STARKEY WAYTELEPHONE:
(619) 445-0035
CITY:ALPINESTATE: CAZIP CODE:
91901
CAPACITY: 4CENSUS: DATE:
04/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee Tamara RoyerTIME VISIT/
INSPECTION COMPLETED:
09:36 AM
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This is an amended report, due to LPA conducting an attempt at an annual inspection on 4/25/24. Actual Inspection was conducted on 4/29/24. See report below:

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Tamara Royer.

The facility is currently licensed for a maximum capacity of four (4) clients of which all must be ambulatory. During today’s inspection, there were a total of one (1) client in care. LPA, accompanied by licensee, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature was compliant.There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects or toxic chemicals/poisons accessible to clients. No medication stored at facility. Facility has locked box for medication. Facility has a jacuzzi onsite, kept locked and secured. Per staff no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and reviewed multiple staff and client records/files. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas.

No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with licensee, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
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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