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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701492
Report Date: 01/14/2026
Date Signed: 01/14/2026 02:48:02 PM

Document Has Been Signed on 01/14/2026 02:48 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:
01/14/2026
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Violet Mubeezi TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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An informal meeting was held on 01/14/2026 at the Sacramento Regional Office via Microsoft Teams. The purpose of the meeting was to discuss instances of non-compliance identified during the Post-Licensing and Case Management visits conducted on 12/12/2025 and 12/15/2025. Participants in the meeting included Licensing Program Manager (LPM) Czarrina Camilon-Lee, Licensing Program Manager (LPM) Troy Ordonez, Licensing Program Analyst (LPA) Pang Lee, Licensing Program Analyst (LPA) Graham Gunby, and the Designated Facility Administrator/Licensee, Violet Mubeezi.

The facility has been licensed since 01/24/2025 and has received a total of twelve (12) Type A citations and two (2) Type B citations. All citations have been addressed through corrective actions. During the meeting, the Informal Conference process, including the Administrative Process, was explained to the Licensee.

The current areas of concern were identified as follows:

• Care and Supervision / Sufficient Staffing

• Personal Rights of Residents

• False Claims

• Basic Services

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: 01/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2026
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: 01/14/2026
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• Reporting Requirements

• Fire Safety

• Limitations – Capacity and Ambulatory Status

• Incidental Medical Services

• Storage Space and Access

The Licensee agreed to conduct additional training in the following areas to bring the facility into compliance. Documentation of completed training, including staff sign-in sheets and the training materials used, is due to the Department by 01/28/2026:

• Personal Rights, including the use of cameras, gates, and locking of pantry and refrigerator

• Basic Services, including adequate staffing

• Reporting Requirements, including designation of responsible staff for reporting and submission of death and incident reports to CCLD

• Incidental Medical Services, including maintaining current resident Medication Administration Records (MAR) logs and Centrally Stored Medication and Destruction Records (CSMDR)

• Maintenance and Operations of the Facility, including ensuring resident bathrooms are equipped with non-slip mats and that all toxins are inaccessible to residents at all times

Failure to maintain substantial compliance, as outlined in the LIC 809 report dated 01/14/2026, may result in a Non-Compliance Conference and referral of the Licensee/Facility to the Legal Department for review and possible administrative action.

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: 01/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2026
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: 01/14/2026
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These actions are intended to be collaborative rather than punitive, with the goal of addressing areas of concern and supporting facility improvement. The facility will be subject to continued monitoring and inspections on a quarterly basis for the next six (6) months to verify sustained compliance. The Licensee/Administrator Mubeezi has agreed to enroll in and utilize services from the Technical Support Program (TSP), which will be coordinated by the Department.

An exit interview was conducted with Licensee/Administrator Mubeezi and a copy of this report will be emailed to the Licensee/Administrator Mubeezi for signature and returned to the Department.

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC809 (FAS) - (06/04)
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