374604471-9-3-2021-08-AS-CLOZ-C6HUQD-20210903154658

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604471
Report Date: 09/03/2021
Date Signed: 09/03/2021 03:49:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	ROSEMARY WARMLANDS SENIOR CARE, INC.		FACILITY NUMBER:	374604471
ADMINISTRATOR:	SKOGLIN, KRISTINE M.		FACILITY TYPE:	740
ADDRESS:	2350 WARMLANDS AVENUE		TELEPHONE:	(619) 871-0285
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	6	CENSUS: 0	DATE:	09/03/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kristine M. Skoglin, Licensee		TIME COMPLETED:	01:55 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	Licensing Program Analyst (LPA) Carmen Lopez conducted an announced Pre-Licensing and Component III inspection at a Residential Care Facility for the Elderly for a change of ownership on today's date to inspect the facility for compliance with Title 22, Division 6, Chapter 8 of the California Code of Regulations and the Health & Safety Code. After arriving at the facility, LPA identified herself, disclosed the purpose of the visit and was granted entry by the Kristine M. Skoglin, Licensee. LPA toured the physical plant, inside and out, and observed the following: Resident accommodations were in compliance with regulations, including furnishings, linens, and personal hygiene items; resident bathrooms were equipped with non-skid flooring, and water temperatures measured at: kitchen faucet #1 117.1 degrees Fahrenheit (F), faucet #2 at 111.8 degrees F, bathroom in bedroom #1 112.6 degrees F, hallway bathroom at 109.4 degrees F, bathroom in bedroom #2 113.8 degrees F, bathroom in bedroom #3 109.8 degrees F, bathroom in bedroom #4 108.0 degrees F, bathroom in bedroom #5 115.9, bathroom in bedroom #6 112.5 degrees F, laundry room at 112.3 degrees F; the facility’s ambient room temperature was 75 degrees F at the time of the visit; medications will be stored in a locked cabinet in the back. Staff records were kept in a secured area in the business office; Resident records were kept in a locked cabinet in the back area. Food service was within the requirements of regulations, including dishes, utensils, food storage, and a seven (7) day supply of non-perishables; the two (2) day supply of perishables will be bought once clients are admitted. Knives and sharp objects were inaccessible to residents in care; toxic substances were stored in a locked cabinet; first aid kits and required supplies were stored in a the back area; the first aid manual was purchased and will be at the facility prior to resident’s acceptance. Activity supplies and sufficient space in which to conduct activities were present; fire extinguishers were present throughout the facility; smoke and carbon monoxide detectors were present and operable; required facility postings were present and visible in the common area of the facility.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ROSEMARY WARMLANDS SENIOR CARE, INC.	FACILITY NUMBER: 374604471
	VISIT DATE: 09/03/2021

NARRATIVE

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According to the Licensee, there are no guns, weapons, or ammunition stored on the facility property. The facility does not have a swimming pool or bodies of water.

LPA conducted and completed the Component III with the Licensee Kristine M. Skoglin during the visit. LPA verified her understanding of Title 22 continuing requirements, including physical environment, reporting requirements, personnel and resident records, incidental medical care, health related services and activities.

No deficiencies were observed during today's visit as all items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8 of the California Code of Regulations and the Health and Safety Code. The Licensee was advised that the application is pending management final review and approval. An exit interview was conducted with her and a copy of this report and Applicant Rights (LIC 9058) were provided to her via electronic mail; she expressed to LPA that she would send an email confirmation upon receipt of these documents.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

LIC809 (FAS) - (06/04)

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