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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700759
Report Date: 05/10/2023
Date Signed: 05/10/2023 10:56:14 AM


Document Has Been Signed on 05/10/2023 10:56 AM - 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 AC/SC, 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: 4DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rosemary Bitancor - AdministratorTIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPA's) Brandon Panariello and Ruth Wallace arrived at facility for the purpose of conducting an unannounced required 1 year annual inspection. LPA's met with Administrator and explained purpose of visit.
LPA's and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, common area and outdoor area. LPA's observed the facility to be free of odor, clean and in good repair. LPA's observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility.
LPA's measured the water temperature, temperature measured at 114.3 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA's observed sufficient seven-'day non-perishable and two day perishable food supplies. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. First aid kit was checked and is complete. LPA's observed centrally stored medications, toxins, and sharps kept locked and inaccessible to clients. LPA's reviewed Fingerprint clearance and associations to the facility. Common touch surfaces are cleaned after each use.

LPA's Received the following documents for facility file on today's date:
LIC 308 - Designation of Administrator, Administrator Certificate, copy of Liability Insurance, and Surety Bond.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection.

An exit interview was conducted with administrator and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) -26-4723
LICENSING EVALUATOR NAME: Brandon PanarielloTELEPHONE: 323-558-2130
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
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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