<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201194
Report Date: 09/08/2022
Date Signed: 09/08/2022 01:55:59 PM

Document Has Been Signed on 09/08/2022 01:55 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ROSEFINI CARE HOME LLCFACILITY NUMBER:
079201194
ADMINISTRATOR:ANYANWU, ROSEMARYFACILITY TYPE:
735
ADDRESS:4632 FAWN HILL WAYTELEPHONE:
(925) 206-4187
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 6CENSUS: 2DATE:
09/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Rosemary Anyanwu, ApplicantTIME COMPLETED:
02:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 09/08/22 at 1:40PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct a Change of Ownership Pre-licensing Required inspection. LPA met with Applicant/Administrator and explained the purpose of the visit. The facility currently has 2 clients. LPA observed one staff wearing face mask during visit. Routine COVID symptom checks was done by staff at the front entrance. Screening station had visitors log, no touch temperature probe, additional masks and hand sanitizers.

LPA toured facility with applicant including but not limited to 4 bedrooms, 3 bathrooms, kitchen, common areas and backyard. COVID signages were observed in the kitchen, bathrooms and common hallways. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with covered trash bins and paper towels on holders. Linens and hygiene supplies were observed inside a cabinet. Medications and toxic chemicals were observed locked in the garage and cabinets. There is sufficient lighting throughout facility. Room temperature was maintained at 77 degrees F and hot water temperature was maintained at 119 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 03/21/22. Pathways inside and outside were observed free of fire hazards.

This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is subject to final approval by CAU. Additional requirements may still be required.

No deficiencies observed during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1