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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005188
Report Date: 05/03/2024
Date Signed: 05/03/2024 12:18:53 PM

Document Has Been Signed on 05/03/2024 12:18 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ROYAL PALMS CARE HOMEFACILITY NUMBER:
306005188
ADMINISTRATOR/
DIRECTOR:
FREDRIC ROBARTFACILITY TYPE:
740
ADDRESS:5929 LOS RAMOS CIRCLETELEPHONE:
(714) 625-9425
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
05/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Fredric Robart - AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Administrator (AD) Fredric Robart has a current Administrators certificate that expires May 10, 2024.

Royal Palms Care Home is a one-story community with six bedrooms and two bathrooms. The facility capacity is 6 and the census was 3 during the annual visit. All residents were observed in the living room during the visit.

During the inspection, all bedrooms and bathrooms were observed. Resident bedrooms had all the requirements and were in compliance with regulation guidelines. Resident bathrooms were in compliance as well. No hazardous cleaning items were observed. Grab bars were tightly secured to the wall. Hot water temperatures were measured in both bathrooms. In bathroom #1 hot water measured at 116.6 degrees Fahrenheit, and in bathroom #2 hot water measured at 109.4 degrees Fahrenheit.

There are two carbon monoxide detectors in both hallways mounted on the wall near resident bedrooms.

In the kitchen knives and sharp objects are locked in a drawer near the stove. Resident medication is locked in the cabinet along with a first aid kit that had all the required items including a first aid manual. The stove was clean and all four burners were in good working order. A fully charged fire extinguisher was observed on top of the refrigerator.

The backyard was clean, organized and walkways were free of tripping hazards. A patio area with a table and chairs was observed. There were two storage sheds in the back yard. One shed was used to store miscellaneous items: old bedframes, personal items that belong to staff, a skateboard, etc. The second shed was used to store blankets that were all still inside the plastic.

Continued on LIC809C

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 HOME
FACILITY NUMBER: 306005188
VISIT DATE: 05/03/2024
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The garage is used to store various items, and according to Administrator Robart, several items in the garage will be picked up and be disposed of. There were two locked cabinets used to store hazardous cleaning solutions, detergents, and hygiene supplies. An additional refrigerator and freezer with an additional perishable food supply, and an additional non perishable food supply was observed. An additional supply of linen was observed. An emergency disaster kit was prepared, and an emergency supply of food was prepared.

Smoke detectors tested operational. An emergency evacuation drill was conducted April 7, 2024, and are conducted quarterly.

A technical violation was given regarding some areas of the physical plant that need to be repaired or replaced. No deficiencies are being cited as a result of today’s visit.

An exit interview was conducted and a copy of this report was provided to Administrator Fredric Robart.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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