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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201194
Report Date: 09/08/2022
Date Signed: 09/08/2022 01:56:48 PM

Document Has Been Signed on 09/08/2022 01:56 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:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Rosemary Anyanwu, ApplicantTIME COMPLETED:
02:20 PM
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During the pre-licensing inspection on 09/08/22, Licensing Program Analyst (LPA) Daisy Panlilio conducted a Component lll presentation with applicant.

During the Component lll presentation, LPA provided applicant information on how to operate the facility within Title 22 regulatory compliance as well as how to avoid common problem areas. Applicant confirmed understanding of Title 22 regulations discussed and agreed to be in compliance.

Exit interview conducted and a copy of this report was provided to applicant.
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)
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