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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005188
Report Date: 07/12/2021
Date Signed: 07/12/2021 08:54:25 AM

Document Has Been Signed on 07/12/2021 08:54 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ROYAL PALMS CARE HOMEFACILITY NUMBER:
306005188
ADMINISTRATOR:FREDRIC ROBARTFACILITY TYPE:
740
ADDRESS:5929 LOS RAMOS CIRCLETELEPHONE:
(714) 625-9425
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
07/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:48 AM
MET WITH:Fredric Robart, AdministratorTIME COMPLETED:
08:52 AM
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Licensing Program Analyst (LPA) Jim August conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into the facility by Administrator Fredric Robart and explained the reason for the visit.

LPA August toured the facility. There are six clients residing in the facility and no active covid-19 cases. LPA observed six clients on site. All clients appeared clean and well taken care of. LPA observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed had ample soap/ sanitizer and appeared clean. Client bedrooms appeared clean and sanitary and had all required components. Facility is taking client's temperatures daily and documenting results. LPA observed the emergency disaster, LIC808 Covid mitigation plan and evacuation plans. Facility has back-up emergency food and water supply as well as PPE supplies.

No citations noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: James August
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2021
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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