<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701249
Report Date: 05/10/2023
Date Signed: 05/10/2023 02:56:47 PM

Document Has Been Signed on 05/10/2023 02:56 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ROYALTON HOMEFACILITY NUMBER:
502701249
ADMINISTRATOR:PATRICK KALU, EKEFACILITY TYPE:
735
ADDRESS:3413 ROYALTON AVENUETELEPHONE:
(929) 998-1037
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 4CENSUS: 0DATE:
05/10/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Patrick & Ester Kalu.TIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Announced pre-licensing visit was with applicants, Patrick & Ester Kalu. LPA Jason Lund explained the reason for the visit.

The facility will be licensed to serve up to (4) clients at any given time. This Applicant was also seeking a program through Regional Center retain up to (4) clients at any given time. Census 0

LPA toured the dining area, living area, and all other areas intended for client use. LPA observed to be furnished and maintained in compliance at this time.

The Facility had a Medication closet (locked) where medication will be stored. First aid kit was observed in the Medication closet to be present and contained all required components at this time.

A tour of the (4) private resident bedrooms, was conducted. Furnishings intended for use by the residents were observed to meet the needs of the residents at this time. The Facility also had an office for staff. The facility also had three restrooms of which one was in the master bedroom.

There is one linen closets, in the hallway, it was observed to contain a sufficient supply of towels and linens able to meet the needs of the clients at this time.

A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. The facility has two fire extinguisher that expire on 5/9/2024 and had a working telephone.
This facility has been found to be in compliance at this time.

Both Patrick & Ester Kalu completed the Component 111 requirements.
Exit Interview and report left.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1