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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802458
Report Date: 11/13/2025
Date Signed: 11/13/2025 01:40:57 PM

Document Has Been Signed on 11/13/2025 01:40 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ROWE RESIDENCEFACILITY NUMBER:
565802458
ADMINISTRATOR/
DIRECTOR:		ROWE, CHRISTINEFACILITY TYPE:
740
ADDRESS:11357 CASA STREETTELEPHONE:
(805) 323-5034
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY: 6CENSUS: 5DATE:
11/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Christine (Tina) Rowe & Toni DartTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:40AM. LPA was greeted by facility staff upon arrival. Licensee Toni Dart was contacted via telephone and arrived at 10:00AM and Administrator arrived shortly thereafter. Entrance interview conducted.
Facility is a single-story residence that consists of five (5) resident bedrooms and three (3) bathrooms. The LPA observed (1) fully charged fire extinguisher and last serviced on 06/23/2025. All hardwired smoke alarms and fire door were tested at 12:48PM and functioned properly during time of visit. LPA observed all required postings in the entrance of the home. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Beginning at 10:08AM, the LPA along with Licensee conducted a tour of the physical plant to ensure there are no health and safety hazards and the facility is in compliance with Title 22 regulation. The following was observed:

BEDROOMS: There are 5 (five) resident rooms; 1 (one) is designated as a shared resident room and the remaining 4 (four) are designated for private resident use. The resident bedrooms were properly furnished with at least one chair, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets.

BATHROOMS: LPA observed all resident bathrooms clean, properly supplied and had functional fixtures. The LPA observed grab bars and slip-resistant surfaces in resident bathrooms. Residents have sufficient amounts of supplies for personal hygiene. Water temperature was measured in the private resident restroom and was 116.8 degrees Fahrenheit, which is within the required range.


Report Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Kelly Dulek
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2025
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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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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROWE RESIDENCE
FACILITY NUMBER: 565802458
VISIT DATE: 11/13/2025
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COMMON AREAS: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The facility maintained a comfortable temperature throughout the visit.

SURROUNDING GROUNDS (OUTDOORS): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. The side gate was observed to be self-closing and latching. All exits were clear and free of hazards.

KITCHEN: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; sharp objects are stored in a locked drawer to the left of the stove.

GARAGE: The locked garage is where the washer and dryer are held. The garage also contains additional non-perishable emergency food and water, storage and personal care supplies, as well as extra food. Cleaning supplies and disinfectants are stored in locked cabinets in the locked garage.

RECORD REVIEW: Beginning at 10:24AM, LPA reviewed staff and resident files for items including, but not limited to: medical assessments, TB clearance, personal rights, staff training records, health screening and personnel records. The LPA reviewed five (5) resident files and five (5) staff files. All staff files reviewed appeared complete and current. Four (4) of five (5) resident files reviewed contained needs and service plans that were dated 10/10/2024 or 11/03/2024, just over 12-months ago.

MEDICATION REVIEW: Medications review began at 12:25PM. LPA reviewed medications for 2 (two) residents. Medications are centrally stored and locked in a cabinet in the kitchen area and in a lockbox in the refrigerator. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record.

EMERGENCY DISASTER PLAN/INFECTION CONTROL PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually, as required. Emergency drills are conducted quarterly, with the last drill documented in August 2025.

No citations issued. Exit interview conducted and copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Kelly Dulek
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC809 (FAS) - (06/04)
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