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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700759
Report Date: 05/25/2021
Date Signed: 05/25/2021 03:02:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ROSEMARY'S WILLOW GROVE HOMEFACILITY NUMBER:
342700759
ADMINISTRATOR:BITANCOR, ROSEMARYFACILITY TYPE:
740
ADDRESS:8559 WILLOW GROVE WAYTELEPHONE:
(916) 688-7576
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:4CENSUS: 3DATE:
05/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Rosemary BitancorTIME COMPLETED:
03:30 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 5/25/21 at 1:30pm, Licensing Program Analysts (LPAs) Kevin Gould and Anthony Tuck arrived at Rosemary's Willow Grove Home for the purpose of conducted an unannounced required 1 year annual inspection. LPAs met with Administrator Rosemary Bitancor and together conducted a walk-though of the facility and reviewed facility COVID mitigation practices.

The facility is a single story home in a residential neighborhood with a capacity for 4 non-ambulatory residents. Current census is 3. LPAs observed the home consists of 4 bedrooms, 2 bathrooms, living room, kitchen dining room and attached garage. bedrooms were equipped with adequate storage and lighting. The facility appeared clean sanitary and in good repair. Food supply for required 2-day perishable and 7-day non perishable food quantities were observed to be sufficient and able to meet the needs of the residents at this time. Fire extinguishers were observed to have been annually assessed on 12/22/2020 by the local fire authority and found to be in compliance at this time. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Laundry area was toured. Cleaners and detergents were observed to be locked and made inaccessible to the residents at this time. Administrator certificate is valid. LPAs inspected a facility vehicle and observed the vehicle to be operational and in compliance at the time of inspection.

Facility is in compliance with their approved mitigation plan.

LPAs inspected the attached garage and observed additional food storage fridge. LPAs inspected the back yard and observed no hazards to residents in care. There were no deficiencies observed or cited during today's annual inspection per Title 22 regulations.

Exit Interview was conducted with Facility Administrator and a copy of the report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021
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