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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701492
Report Date: 01/23/2025
Date Signed: 01/23/2025 10:46:26 AM

Document Has Been Signed on 01/23/2025 10:46 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ROWENA CARE HOMEFACILITY NUMBER:
342701492
ADMINISTRATOR/
DIRECTOR:		MUBEEZI, VIOLETFACILITY TYPE:
740
ADDRESS:1367 ROWENA WAYTELEPHONE:
(301) 541-4028
CITY:SACRAMENTOSTATE: CAZIP CODE:
95864
CAPACITY: 6CENSUS: 0DATE:
01/23/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Violet MubeeziTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 01/23/25 at 8:30 AM Licensing Program Analyst (LPA) Pang Lee arrived announced to conduct a Pre-Licensing follow-up inspection of the facility to ensure compliance with Title 22 regulations. LPA Lee met with applicant Violet Mubeezi who assisted LPA in today’s inspection.

LPA Lee toured the facility with the applicant. During today's visit, LPA observed the green house in the courtyard being used as a storage. LPA Lee observed miscellaneous items in the in the green house and it was observed to be locked. Per applicant resident will not have access to the green house. LPA Lee did advise the applicant to clean out the green house. Applicant stated that she will have the greenhouse clean by end of day 01/27/25 and send LPA Lee pictures via email. LPA Lee observed the following corrections were completed:

· A plan of operation to include the 4 cameras in the facility was submitted on 01/14/25 to centralized applications bureau (CAB) for review.

· Licensee updated facility sketch to include the four cameras in the facility, laundry room and designated office.

· Licensee removed personal belongings in residents’ bedrooms.

· Resident bedrooms are equipped with drawers and a chair.

· Observed all residents’ bathrooms showers have non-slip mats and grab bars and are sturdy.

· Observed the cabinet in the kitchen where the knifes are store and the cabinet in resident bathroom 3 are in good repair.

Continued LIC 809-C

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/23/2025
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· Observed rolled carpets, mattress, bedframes, boards, miscellaneous items in resident bedrooms are remove.

· Complaint poster PUB 475 in the size of 20”X26” is posted in the entry of the facility.

· The crawl space on the side of the facility is made inaccessible to residents in care.

· The exposed wires, wood planks and miscellaneous items in the courtyard and garage was disposed.

· The facility has sufficient 2 days perishable food at all times.

· A rail was installed in the back porch to prevent residents from falling over.

LPA reviewed Component 3 with the applicant. The applicant has passed the pre-licensing component of the application process. LPA will notify the CAB that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was given to the applicant.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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