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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507002686
Report Date: 01/02/2025
Date Signed: 01/02/2025 09:27:15 PM

Document Has Been Signed on 01/02/2025 09:27 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:VALLEY ROYALE CAREFACILITY NUMBER:
507002686
ADMINISTRATOR/
DIRECTOR:		GENARO BAISACFACILITY TYPE:
740
ADDRESS:701 FLEETWOOD DRIVETELEPHONE:
(209) 577-3818
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
01/02/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Adiministrator Genaro BaisacTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Jason Lund made an unannounced visit to the care home to conduct an Annual/Required inspection. LPA was met by Administrator Genaro Baisac and explained the reason for the visit. Census:3

LPA Lund and Administrator Genaro Baisac toured/Inspected the facility. There are three bedrooms and two bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The two bathrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke detectors and carbon monoxide detector found in working order. Fire extinguishers (3/24/2024) and first aid kit are maintained and ready for emergency use. LPA Lund reviewed two staff & two residents files and were in compliance.

No deficiencies were cited during the visit. Exit interview conducted and copy of report left.
Lisa RiosTELEPHONE: (916) 969-9685
Jason LundTELEPHONE: (916) 223-6752
DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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