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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804243
Report Date: 01/15/2025
Date Signed: 01/15/2025 10:32:21 AM

Document Has Been Signed on 01/15/2025 10:32 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NAPA VALLEY ROYALE INCFACILITY NUMBER:
286804243
ADMINISTRATOR/
DIRECTOR:		SIMPSON, MICHELLEFACILITY TYPE:
740
ADDRESS:3851 LINDA VISTA AVETELEPHONE:
(925) 214-7415
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY: 6CENSUS: 0DATE:
01/15/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Michelle SimpsonTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility for the purpose of completing a pre-licensing evaluation. LPA met with Applicant and toured the facility. The following areas were noted during the previous inspection on 11/27/2024:

Backyard sidewalk trip hazards: LPA observed the trip hazards have been corrected on the walkways in the backyard.

Rear deck repair: Boards have been replaced on the rear deck.

7 day hot water temperature log: Temperature log was completed by applicant and water was tested within regulation during this visit.

Night light in hallway to common bathroom: Lights have been installed to light the walkways inside.

Lock on staff bathroom door: Combination lock installed.

Background clearance: Paperwork is being worked on and will be submitted by the deadline.

Component III orientation was conducted at facility on 11/27/2024.

The pre-licensing evaluation has been completed. LPA will submit the application packet for a final review and approval from the Licensing Program Manager.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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