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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604297
Report Date: 10/04/2023
Date Signed: 10/04/2023 09:17:19 AM

Document Has Been Signed on 10/04/2023 09:17 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ROYAL RESIDENTIAL CAREFACILITY NUMBER:
374604297
ADMINISTRATOR:PETROV, JULIANFACILITY TYPE:
735
ADDRESS:2324 WIND RIVER RDTELEPHONE:
(619) 447-2473
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 4CENSUS: 4DATE:
10/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Licensee Julian PetrovTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Julian Petrov.

On 06/29/2023, the Licensee submitted an LIC200 Application to the CCLD San Diego Regional Office (RO) to change the facility's floor plan. The change involved creating an additional client bedroom ("Bedroom #5" per the facility sketch).

On 09/29/2023, the local fire authority granted an updated fire clearance, showing the facility’s bedroom addition was approved. There were no changes to the facility’s licensed capacity or ambulatory status.



During today’s visit, LPA conducted a brief tour of the facility and viewed the bedroom addition. The updated facility sketch/floor plan was consistent with the current layout of the facility.

LPA observed no immediate health or safety issues. No deficiencies were cited.

This portion of the application process is complete. Pending CCLD management’s final review and approval, the licensee will be sent an updated license to reflect the new fire clearance.

An exit interview was conducted with Petrov. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the licensee during the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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