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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701492
Report Date: 10/29/2024
Date Signed: 10/29/2024 10:52:41 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/23/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241023150308
FACILITY NAME:ROWENA CARE HOMEFACILITY NUMBER:
342701492
ADMINISTRATOR:MUBEEZI, VIOLETFACILITY TYPE:
740
ADDRESS:1367 ROWENA WAYTELEPHONE:
(301) 541-4028
CITY:SACRAMENTOSTATE: CAZIP CODE:
95864
CAPACITY:6CENSUS: 0DATE:
10/29/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Violet MubeeziTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Unlicensed Care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Vincent Moleski, Holly Williams, and Kevin Gould arrived unannounced to open this complaint investigation. The LPAs met with operator Violet Mubeezi and explained the purpose of the visit. Mubeezi currently has an application pending with the Central Applications Bureau for a license to care for elderly residents.

LPAs Moleski and Williams toured the property and observed no currently residents in care. In an interview, Mubeezi said that she has been caring for one resident (R1), who is currently at the hospital. Mubeezi said that R1 has been receiving services since moving in on 10/4/24. According to Mubeezi, these services include assistance with medication, the central storing of medications, assistance with meal service, assistance with showers, assistance with making medical appointments, supervision, and maintenance of R1's restricted diet. Mubeezi said that R1 does not have any cash resources stored at the property. [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20241023150308
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ROWENA CARE HOME
FACILITY NUMBER: 342701492
VISIT DATE: 10/29/2024
NARRATIVE
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LPA Moleski interviewed a staff member present at the property upon arrival (S1). S1 said that R1 has been living at this property for approximately two to three weeks. S1 said they provide assistance to R1 with meals, showers, medications, arranging medical care, and maintenance of R1's restricted diet. R1 was sent to the hospital on Saturday October 26, 2024, according to Mubeezi. S1 said they had called emergency medical services on that date because S1 was experiencing weakness and shortness of breath.

LPA Moleski observed R1's room to contain various personal belongings. LPA Moleski observed R1's medications were being kept in a locked cabinet in the kitchen.

LPA Moleski reviewed R1's file, which contained an admission agreement for Residential Care Facilities for the Elderly. The admission agreement contained provisions for basic services as defined by Title 22 of the California Code of Regulations. R1's file contained an LIC 602, Physician's Report for Residential Care Facilities for the Elderly. R1's file also contained various medical records from R1's previous placement.

The department has determined the following as it relates to the allegation that unlicensed care is being provided.

Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.

A notice of violation of law was issued to Mubeezi. An exit interview was held with Mubeezi. Appeal rights and a copy of this report were left with Mubeezi.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2