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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701492
Report Date: 01/12/2026
Date Signed: 01/12/2026 02:35:37 PM

Document Has Been Signed on 01/12/2026 02:35 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
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: 5DATE:
01/12/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:39 AM
MET WITH:Edgar Odongkara and Violet MubeeziTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 01/02/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection and Plan of Correction (POC) visit. LPA Lee met with direct care staff Edgar Odongkara and explained the purpose of the visit. LPA Lee requested that care staff Odongkara inform Administrator Violet Mubeezi that CCLD was present at the facility. Approximately 45 minutes later, Administrator Mubeezi arrived and joined the inspection.

Upon arrival, LPA Lee observed another individual accompanying Administrator Mubeezi. When questioned, Administrator Mubeezi identified the individual as her sister-in-law (SIL). When LPA Lee asked whether the SIL was a resident, based on LPA Lee’s interaction, the SIL appeared unable to understand the questions being asked. Approximately two hours later, the facility arranged for Uber transportation to return SIL to 1001 Tamarack Ct., Roseville, CA accompany by staff 1 (S1). Administrator Mubeezi stated that both she and her SIL reside at that address. Administrator Mubeezi holds Certificate #7034316740, which expires on 09/09/2027. The facility’s current census is five (5) residents, with two (2) staff members on duty.

The facility is a single-story building licensed to serve six (6) ambulatory residents, of whom up to six (6) may be non-ambulatory, with a hospice care waiver granted for four (4) residents. LPA Lee inspected the physical plant, including but not limited to the common areas, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, garage, staff office, and outdoor courtyards, to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be clean, free of odors, and in good repair. Resident bedrooms were properly furnished with appropriate bedding and adequate lighting.

CONTINUED LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 01/12/2026
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 No bodies of water were present on the premises. In the kitchen, LPA Lee observed sufficient seven-day nonperishable and two-day perishable food supplies. Hot water temperature measured 109.6 degrees Fahrenheit at a resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. Smoke detectors and carbon monoxide detectors were observed to be in compliance. The fire extinguisher was located in the dining area and resident hallway and was last serviced in 12/2025. The most recent fire drill was conducted on 12/23/2025. LPA Lee observed a public telephone located in the kitchen and common area and verified that all required postings were displayed. The facility thermostat was observed at 71 degrees Fahrenheit, which is within the required range of 68 to 85 degrees Fahrenheit. Toxic substances were observed stored under the kitchen sink, locked, and inaccessible to residents. Sharp knives were observed locked in a kitchen cabinet and inaccessible to residents. Medications were observed to be locked and inaccessible to residents. The first aid kit was inspected and contained all required components. LPA Lee did not observe any cameras and baby gates in resident bedrooms. LPA Lee also did not observe any residents occupying staff rooms.

LPA Lee audited medications for three (3) of five (5) residents by comparing medications on hand with Medication Administration Records (MARs) and determined that the records were not accurate. Resident 1 (R1) had three (3) medications listed on the MAR that were not present in the resident’s medications on hand. Resident 2 (R2) had two (2) medications listed on the MAR that were not present on hand. Per Staff 1 (S1), the medications were expected to be delivered to the facility, refills were not requested by staff, and medications are automatically generated by the pharmacy. Administrator Mubeezi provided LPA Lee with the name of the coordinator responsible for overseeing resident medications and MARs. LPA Lee will follow up with the coordinator. LPA Lee reviewed five (5) of five (5) resident files and found them to be complete. LPA Lee also reviewed two (2) staff files, which were complete.

LPA Lee reviewed staff criminal record clearances. Review of records indicated that all facility staff or individuals requiring caregiver background checks must be fingerprint cleared and associated to the facility. Since the SIL was not fingerprinted and associated, Administrator Mubeezi had the SIL leave the facility. LPA Lee informed facility staffs that family members or other individuals who are not fingerprint cleared and associated with the facility are not permitted to be on the premises.



CONTINUED LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026
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: 01/12/2026
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The following documents were provided to LPA Lee during today’s visit:
(1) LIC 308 Designation of Administrative Responsibility
(2) Copy of Administrator Certificate
(4) LIC 610 Current Emergency Disaster Plan
(5) Proof of Current Liability Insurance
(6) LIC 500 Current Personnel Report


Additionally, the purpose of this visit was to also verify the plan of correction that was required to be completed on 12/19/2025 and 12/29/2025 for deficiencies that were previously cited on two prior visits conducted on 12/12/2025 and 12/15/2025.

Based upon this inspection, LPAs observed the following:

The following deficiencies cited under Title 22 Regulation have been cleared. The license did comply with the terms of the POC-by-POC due date. A POC letter was generated and provided to the licensee:
· 87309(a)(1), 87465(a)(6), 87203, 87204(a), 87303(e)(5), 87307(d)(6), 87405(d)(2), 87211(a)(1)(D), 87468.2(a)(1), 87468.1(a)(6), 87468.1(a)(3), 87207, 87464(d)
and 87465(a)(4).

As a result of this annual inspection and POC visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with care staff Odongkara a copy of these LIC 809 reports was provided to the facility.
NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026
LIC809 (FAS) - (06/04)
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