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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604471
Report Date: 05/13/2022
Date Signed: 05/13/2022 10:15:31 AM


Document Has Been Signed on 05/13/2022 10:15 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:ROSEMARY WARMLANDS SENIOR CARE, INC.FACILITY NUMBER:
374604471
ADMINISTRATOR:SKOGLIN, KRISTINE M.FACILITY TYPE:
740
ADDRESS:2350 WARMLANDS AVENUETELEPHONE:
(619) 871-0285
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:6CENSUS: 4DATE:
05/13/2022
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kristine Skoglin, AdministratorTIME COMPLETED:
10:20 AM
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Licensing Program Analyst Tricia Danielson, and County of San Diego Nurse HAI Site Assessment Contractors, Robert Montillano and Sandra Brackman conducted an announced on-site visit. The team identified themselves and discussed the purpose of the visit with Administrator, Kristine Skoglin.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment related to COVID-19. During today's visit, the team interviewed Skoglin and conducted a walk-through of the facility. A debriefing was conducted with Skoglin at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Skoglin and a copy of this report was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022
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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