502701249-5-14-2026-27-AS-NWPN-DU3REU-20260514125808

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 502701249
Report Date: 05/14/2026
Date Signed: 05/14/2026 12:58:15 PM

Document Has Been Signed on 05/14/2026 12:58 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 HOME		FACILITY NUMBER:	502701249
ADMINISTRATOR/ DIRECTOR:	PATRICK KALU, EKE		FACILITY TYPE:	735
ADDRESS:	3413 ROYALTON AVENUE		TELEPHONE:	(929) 998-1037
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY: 4		CENSUS: 3	DATE:	05/14/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Eke Patrick Kalu and Ester Kalu		TIME VISIT/ INSPECTION COMPLETED:	01:00 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	Licensing Program Analyst, LPA, Noel Wolf Petersen arrived to the facility to conduct an annual inspection, LPA met with the administrator Patrick Kalu at the home around 9:45 am. This is a continuation of an annual from a previous attempted visit, 4/130/26. Royalton Home is a 4 bedroom facility with 3 current residents, aged 18-59 both male and female. There are no restricted care clients at the time of the visit. Physical inspection included but was not limited to the kitchen common areas, resident bedrooms, resident bathrooms, storage areas, exteriors and emergency route gate. The kitchen had adequate stored foods for 3 clients:(2days perishable + 7 days non perishable +3 days emergency) meals and snacks. The sharps and toxics are locked in the storage area. Medications were reviewed against mars for 2 clients, during one gap a client had logged out a week of medication for a vist with family, and returned with not having taken that medication. the client is self responsbile, and the LPA asked the facility to log the missed doses as having been checked out and returned to the facility, and then log the return of those missed doses to the pharmacy. Another client is wanting to consume marijuana for medical purposes on the facility grounds, the facility has a house rule against the use of recreational drugs but is willing to store and centrally manage some form of prescribed marijuana. LPA gave guidance that the facility should encourage the client to pursue getting a perscription and participate with the facility's house rules. A review of the P+I for the only client reciving funds was conducted, she only needed her final balance number updated. The remaining to clients, one has a payee service that driectly makes funds a vailible to the cliens bank, the other is transplanted from another county within the last month and is having an issue with restarting his monies. Continued on c page.

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Noel Wolf Petersen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ROYALTON HOME	FACILITY NUMBER: 502701249
	VISIT DATE: 05/14/2026

NARRATIVE

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The common areas and exterior are clean, well lit and free of obstruction.

The bathrooms have hardware in good repair, the water temperature was measured between 105-120*F.

Bedrooms have required furniture and furnishings, excluding matress encasements.

Evacuation route gate is slightly rusted, lpa gave guidance to lubricate, does not yet present an obstruction.

Full linen, fire extinguisher is dated 3/4/26, and the first aid kit is present and contains all required items. smoke/co alarm is functional.

No clients or staff in the home at the time of the visi, no interviewst. the three clients have either day program or ged type classes, the administrator is availible as the on-call staff when a client would come home early from day program. Clients are on the higher end of functioning.

The administrator files were reviewed for required facility posters(ombudsman, federal workers rights, client rights, facility sketch with evacuation route, and facility license), the infection control plan, control of property, evacuation control plan, and liability/workers comp insurances. docs are present and up to dated.

The staff files were reviewed for background clearances, continuing and initial training, health screenings, and cpr/first aid training. documents are present and up to date.

The client files were reviewed for signed admission agreements, needs and services plans, recent IPP's and 602's, and health screenings. documents are present and up to date.

No citations issued at this time. A copy of the report was read and given to the administrator. exit interview was conducted.

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Noel Wolf Petersen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

LIC809 (FAS) - (06/04)

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