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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701249
Report Date: 05/16/2024
Date Signed: 05/16/2024 10:15:17 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/16/2024 10:15 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ROYALTON HOMEFACILITY NUMBER:
502701249
ADMINISTRATOR/
DIRECTOR:
PATRICK KALU, EKEFACILITY TYPE:
735
ADDRESS:3413 ROYALTON AVENUETELEPHONE:
(929) 998-1037
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 4CENSUS: 0DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Administrator Patrick KaluTIME VISIT/
INSPECTION COMPLETED:
03:00 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
LPA Lund arrived announced to conduct and post-licensing visit with Administrator Patrick Kalu. LPA Jason Lund explained the reason for the visit. Census:0 The facility is still waiting approval from Regional Center for services.

The facility is licensed to serve up to (4) clients at any given time. LPA Lund & Patrick Kalu toured/inspected 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 has 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 expires on 5/9/2025 and had a working telephone.

No deficiencies cited during today’s visit. Exit interview held and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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