Rosemary's Willow Grove Home

Type of visit: Required - 1 Year

On 04/22/2026 at 8:35 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with the facility designated administrator Rosemary. The current census is 4 with 2 facility staff present. This facility is a single story building licensed to serve (4) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 110.0 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the entry way and was last serviced on 01/29/2026. LPA observed the facility has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 68 degrees Fahrenheit. LPA observed toxins located in the kitchen cabinet kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 2 out of 4 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 4 out of 4 resident files and they were complete. LPA reviewed 3 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by 04/23/2026 (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulations, and a copy of these LIC 809 report were provided to the facility.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Required - 1 Year

On 5/20/25 at 9:00 AM, Licensing Program Analyst (LPA) Cynthia Tamayo arrived at the facility to conduct an unannounced annual inspection. LPA Tamayo met with Licensee, Rosemary Bitancor and explained the purpose of the visit. Licensee assisted with today’s visit. Administrator certificate # is 6017166740and will expire on 7/7/2025. The current census is 3 with 2 facility staff. This facility is a single story building licensed to serve six (4) non-ambulatory residents. LPA Tamayo inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Tamayo observed the facility to be free of odor, clean and in good repair. There are no bodies of water present. LPA observed the following: KITCHEN: Appliances and fixtures were clean and functional. LPA observed seven-day non-perishable and two-day perishable food supplies. Meals are prepared by the Staff. Fridge temperature was at 45 degrees F and freezer temperature was at 0 degrees F. Knives and other sharps are locked inaccessible in a drawer. Kitchen and house cleaning supplies are stored in a locked cabinet located under the sink. COMMON AREAS: Common areas include the Living Room and Dining Room. All furniture was observed to be clean and in good condition, with ample seating. There was space to accommodate both indoor and outdoor activities. LPA noted an Activity Calendar in the hallway and activity storage in the living room area. Continued on 809-C One (1) fire extinguisher was observed throughout the common areas and was last serviced on 01/2025, and checked monthly. Smoke and carbon monoxide detectors are in compliance with fire safety. LPA observed the facility has a has a public telephone in the kitchen area and the facility has the required posters posted. Facility thermostat was observed at 74 degrees Fahrenheit. The first aid kit was checked and contained the required components. GARAGE: LPA observed toxins located in the garage kept locked and inaccessible to residents and general extra stored items including but not limited to paper goods, washer machine and dryer. EXTERIOR: Exterior passageways were clean and clear of any obstructions. There is a covered patio area for client and visitor use with furniture observed to be in good condition. Clients are supervised at all times when they are outside. There are two (2) gates with a self-latching mechanism for persons to exit the backyard in emergencies. LPA observed a locked shed which contains general supplies. BEDROOMS: LPA inspected facility bedrooms. The facility has five (4) total private bedrooms. All bedrooms were observed to contain furniture, bedding and linens within regulation. Extra linens are stored in the hallway cabinet. Client bedrooms had no visible hazards or inconsistencies observed. BATHROOMS: There are two (2) bathrooms: one (1) is a private bathroom attached to a resident bedroom and one (1) is a shared bathroom located in the hallway. All bathrooms were observed to be clean and sanitary, and supplied with paper and hygiene products. Water temperature was tested and measured at 114.2 degrees F in the kitchen and 105 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. MEDICATION REVIEW: LPA reviewed medications which are centrally stored in a locked cabinet in the hallway. All medications were stored and administered in compliance with regulation. RECORD REVIEW: LPA reviewed four (4) resident file records at 10:30PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Resident files reviewed contained all required documents. LPA reviewed four (2) staff records during today's visit. Continued on 809-C Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All staff records reviewed were in compliance at the time of the visit. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility's infection control plan as well as the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are within regulation. Both documents were observed to be complete and recently updated. Emergency disaster drill is conducted quarterly per regulation with the last drill documented on 05/04/2025. Personal Protection Equipment (PPE) and extra emergency supplies, including emergency food and water, are stored in the garage. LPA Tamayo requested resident and staff files for review. LPA reviewed 4 resident files and they were complete. LPA reviewed 2 staff files and it was complete. LPA reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents were collected and will be added to the facility file: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report (7) LIC 309 Administrator Organization As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with the Licensee, and a copy of these LIC 809 reports were provided to the facility.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Required - 1 Year

On 4/19/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Administrator Rosemary Bitancor and explained the purpose of the visit. Administrator holds current certification #6017166740 and expires on 7/7/2025. The facility is licensed to serve up to four (4) non-ambulatory residents. There are currently four residents in care. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, garage, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 111*F which was within the required range of 105-120*F. The temperature inside the facility measured at 75*F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. Proof of current liability insurance was observed. Report continued on 809-C LPA requested resident and staff files for review. LPA reviewed (2) staff files and (4) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following forms and documents were received during today’s visit: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed. Exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 19, 2024