Rowena Care Home

Type of visit: Case Management - Deficiencies

On 6/30/26 Licensing Program analyst conducted an Case Management deficiencies inspection to address deficiencies observed while conducting an unrelated complaint investigation. LPA met with Administrator Violet Mubeezi and together discussed LPA's observations. Upon entry, LPA conducted a walk through of the facility and observed all medication cabinets to be unlocked and accessible to residents in care. LPA inspected the food supply and observed items required to be refrigerated after opening in pantry closet and expired. LPA observed expired canned goods. LPA also observed sharp knives and cleaning supplies under the sink and the cabinet was also unlocked and items were accessible to residents in care. Per the California Code of Regulations, Title 22, the following deficiencies are cited during today's inspection. Immediate civil penalty were issued during today's inspection. Exit interview conducted and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jun 30, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a)(1) · Plan of correction due date: Jul 1, 2026

Storage Space and Access: Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by LPA observations of the cleaning supplies and sharp objects left in an unlocked cabinet an unattended which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 30, 2026

Plan of correction: Licensee has agreed to change the locks to automatic locking mechanisms for medication cabinets to ensure the cabinets are never left unlocked or items accessible to residents in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87555(b)(8) · Plan of correction due date: Jul 1, 2026

General Food Service Requirements: All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement was not met as evidenced by LPA observation of expired canned food items and improper storage of items such as an opened mayonnaise in a cabinet that is required to be refrigerated after opening which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 30, 2026

Plan of correction: Licensee has agreed to develop a kitchen food storage plan in writing and submit to LPA by the POC due date 7/1/26. The plan will include what food items are to be inspected, how often and the steps staff will take to ensure food items are of good quality.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jul 1, 2026

Incidental Medical and Dental Care: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by LPA observations of both medication cabinets were observed to be unlocked and accessible to residents in care which poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 30, 2026

Plan of correction: Licensee has agreed to change the locks to automatic locking mechanisms for medication cabinets to ensure the cabinets are never left unlocked or items accessible to residents in care.

Type of visit: Office

An informal meeting was held on 01/14/2026 at the Sacramento Regional Office via Microsoft Teams. The purpose of the meeting was to discuss instances of non-compliance identified during the Post-Licensing and Case Management visits conducted on 12/12/2025 and 12/15/2025. Participants in the meeting included Licensing Program Manager (LPM) Czarrina Camilon-Lee, Licensing Program Manager (LPM) Troy Ordonez, Licensing Program Analyst (LPA) Pang Lee, Licensing Program Analyst (LPA) Graham Gunby, and the Designated Facility Administrator/Licensee, Violet Mubeezi. The facility has been licensed since 01/24/2025 and has received a total of twelve (12) Type A citations and two (2) Type B citations. All citations have been addressed through corrective actions. During the meeting, the Informal Conference process, including the Administrative Process, was explained to the Licensee. The current areas of concern were identified as follows: • Care and Supervision / Sufficient Staffing • Personal Rights of Residents • False Claims • Basic Services CONTINUED LIC 809-C • Reporting Requirements • Fire Safety • Limitations – Capacity and Ambulatory Status • Incidental Medical Services • Storage Space and Access The Licensee agreed to conduct additional training in the following areas to bring the facility into compliance. Documentation of completed training, including staff sign-in sheets and the training materials used, is due to the Department by 01/28/2026: • Personal Rights, including the use of cameras, gates, and locking of pantry and refrigerator • Basic Services, including adequate staffing • Reporting Requirements, including designation of responsible staff for reporting and submission of death and incident reports to CCLD • Incidental Medical Services, including maintaining current resident Medication Administration Records (MAR) logs and Centrally Stored Medication and Destruction Records (CSMDR) • Maintenance and Operations of the Facility, including ensuring resident bathrooms are equipped with non-slip mats and that all toxins are inaccessible to residents at all times Failure to maintain substantial compliance, as outlined in the LIC 809 report dated 01/14/2026, may result in a Non-Compliance Conference and referral of the Licensee/Facility to the Legal Department for review and possible administrative action. CONTINUED LIC 809-C These actions are intended to be collaborative rather than punitive, with the goal of addressing areas of concern and supporting facility improvement. The facility will be subject to continued monitoring and inspections on a quarterly basis for the next six (6) months to verify sustained compliance. The Licensee/Administrator Mubeezi has agreed to enroll in and utilize services from the Technical Support Program (TSP), which will be coordinated by the Department. An exit interview was conducted with Licensee/Administrator Mubeezi and a copy of this report will be emailed to the Licensee/Administrator Mubeezi for signature and returned to the Department.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Required - 1 Year

On 01/02/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection and Plan of Correction (POC) visit. LPA Lee met with direct care staff Edgar Odongkara and explained the purpose of the visit. LPA Lee requested that care staff Odongkara inform Administrator Violet Mubeezi that CCLD was present at the facility. Approximately 45 minutes later, Administrator Mubeezi arrived and joined the inspection. Upon arrival, LPA Lee observed another individual accompanying Administrator Mubeezi. When questioned, Administrator Mubeezi identified the individual as her sister-in-law (SIL). When LPA Lee asked whether the SIL was a resident, based on LPA Lee’s interaction, the SIL appeared unable to understand the questions being asked. Approximately two hours later, the facility arranged for Uber transportation to return SIL to 1001 Tamarack Ct., Roseville, CA accompany by staff 1 (S1). Administrator Mubeezi stated that both she and her SIL reside at that address. Administrator Mubeezi holds Certificate #7034316740, which expires on 09/09/2027. The facility’s current census is five (5) residents, with two (2) staff members on duty. The facility is a single-story building licensed to serve six (6) ambulatory residents, of whom up to six (6) may be non-ambulatory, with a hospice care waiver granted for four (4) residents. LPA Lee inspected the physical plant, including but not limited to the common areas, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, garage, staff office, and outdoor courtyards, to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be clean, free of odors, and in good repair. Resident bedrooms were properly furnished with appropriate bedding and adequate lighting. CONTINUED LIC 809-C No bodies of water were present on the premises. In the kitchen, LPA Lee observed sufficient seven-day nonperishable and two-day perishable food supplies. Hot water temperature measured 109.6 degrees Fahrenheit at a resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. Smoke detectors and carbon monoxide detectors were observed to be in compliance. The fire extinguisher was located in the dining area and resident hallway and was last serviced in 12/2025. The most recent fire drill was conducted on 12/23/2025. LPA Lee observed a public telephone located in the kitchen and common area and verified that all required postings were displayed. The facility thermostat was observed at 71 degrees Fahrenheit, which is within the required range of 68 to 85 degrees Fahrenheit. Toxic substances were observed stored under the kitchen sink, locked, and inaccessible to residents. Sharp knives were observed locked in a kitchen cabinet and inaccessible to residents. Medications were observed to be locked and inaccessible to residents. The first aid kit was inspected and contained all required components. LPA Lee did not observe any cameras and baby gates in resident bedrooms. LPA Lee also did not observe any residents occupying staff rooms. LPA Lee audited medications for three (3) of five (5) residents by comparing medications on hand with Medication Administration Records (MARs) and determined that the records were not accurate. Resident 1 (R1) had three (3) medications listed on the MAR that were not present in the resident’s medications on hand. Resident 2 (R2) had two (2) medications listed on the MAR that were not present on hand. Per Staff 1 (S1), the medications were expected to be delivered to the facility, refills were not requested by staff, and medications are automatically generated by the pharmacy. Administrator Mubeezi provided LPA Lee with the name of the coordinator responsible for overseeing resident medications and MARs. LPA Lee will follow up with the coordinator. LPA Lee reviewed five (5) of five (5) resident files and found them to be complete. LPA Lee also reviewed two (2) staff files, which were complete. LPA Lee reviewed staff criminal record clearances. Review of records indicated that all facility staff or individuals requiring caregiver background checks must be fingerprint cleared and associated to the facility. Since the SIL was not fingerprinted and associated, Administrator Mubeezi had the SIL leave the facility. LPA Lee informed facility staffs that family members or other individuals who are not fingerprint cleared and associated with the facility are not permitted to be on the premises. CONTINUED LIC 809-C The following documents were provided to LPA Lee during today’s visit: (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 Additionally, the purpose of this visit was to also verify the plan of correction that was required to be completed on 12/19/2025 and 12/29/2025 for deficiencies that were previously cited on two prior visits conducted on 12/12/2025 and 12/15/2025. Based upon this inspection, LPAs observed the following: The following deficiencies cited under Title 22 Regulation have been cleared. The license did comply with the terms of the POC-by-POC due date. A POC letter was generated and provided to the licensee: · 87309(a)(1), 87465(a)(6), 87203, 87204(a), 87303(e)(5), 87307(d)(6), 87405(d)(2), 87211(a)(1)(D), 87468.2(a)(1), 87468.1(a)(6), 87468.1(a)(3), 87207, 87464(d) and 87465(a)(4). As a result of this annual inspection and POC visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with care staff Odongkara a copy of these LIC 809 reports was provided to the facility.the state’s words, verbatim · CDSS document, Jan 12, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 12/15/2025, Licensing Program Analyst (LPA) Pang Lee conducted an unannounced visit to the facility to complete a continued Post-Licensing inspection initiated on 12/12/2025. LPA Lee met with care staff Linjey Peart, who notified the licensee/administrator, Violet Mubeezi, of LPA’s presence. Approximately 30 minutes later, Administrator Mubeezi arrived at the facility, and LPA Lee explained the purpose of the visit. The facility census is 6 residents, with two staff members on duty. Administrator Mubeezi informed LPA Lee that resident R3 had been transferred to a skilled nursing facility and that R3’s responsible party had collected approximately half of R3’s belongings and will collect the rest at a later date. LPA Lee did observe that some of R3’s belongings remained in the resident’s room. The administrator holds a current certificate expiring on 09/09/2027. The facility is licensed for 6 non-ambulatory residents, has hospice waivers for 4 residents, and currently has one resident receiving hospice services. LPA Lee inspected the physical plant, including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, and outdoor courtyards, to assess compliance with Title 22 regulations. LPA Lee reviewed seven resident files on 12/12/2025 and today and they were not properly maintained or complete. All 7 resident files were missing Needs and Services Plans. R1’s file did not contain an LIC 602 Physician’s Report and tuberculosis (TB) clearance. LPA Lee was informed that R1 was transported to the emergency room, and the documents were provided to emergency medical personnel. CONTINUED LIC 809-C LPA Lee advised the administrator to maintain duplicate copies of required documents so one copy may be provided to emergency responders while another remains in the resident’s file. Additionally, LPA Lee reviewed the Centrally Stored Medication and Destruction Record (CSMDR) and Medication Administration Records (MARs) and found them to be inaccurate and not properly maintained. It was also learned that two of the seven residents had emergency room visits for which incident reports were neither completed nor submitted to the Department. Administrator Mubeezi acknowledged this omission. R3’s file did not have admission agreement for Rowena Care Home; however, the admission agreement was for Administrator’s other facility Crown Point Villa. Two staff files were reviewed and found to be complete. During 12/12/2025 visit, LPA Lee reviewed 2 out of 7 residents’ medication and it was learned that R7 had two medications that did not have a doctor's order to be administer to R7. R1 had 3 medications that were on hand; however, it was not documented in R1's CSMDR. LPA Lee advised that all residents’ medications need doctor’s order even medications that resident’s responsible party brings to the residents/facility. During the visit, LPA Lee observed that the lock previously attached to the refrigerator had been removed. However, a lock was observed on the pantry. Staff 1 (S1) stated that the pantry is locked at times. LPA Lee advised that neither the pantry nor the refrigerator may be locked in a manner that restricts resident access. The lock on the pantry was removed by S1 during the visit. The facility was observed to have an adequate supply of food. LPA Lee further observed that toxins and knives were accessible to residents in care. Administrator Mubeezi stated that cabinet locks had been ordered but would not be delivered until Wednesday. LPA Lee advised that these items be immediately secured in a locked area until the locks arrive. Administrator Mubeezi complied by relocating the items to a secured locked cabinet. During LPA Lee’s visit on 12/12/2025, S1 was observed seated in staff room #4 supervising resident R7. S2 was observed sleeping in resident room #8, as S2 was assigned to the NOC shift. LPA Lee questioned the facility’s ability to provide adequate care and supervision to the remaining residents, as only one awake care staff member was on duty and was observed spending the majority of the visit in staff room #4 with the door closed while supervising R7 which raised concerns regarding who was providing care and supervision to the remaining residents during that time. CONTINUED LIC 809-C LPA Lee observed that the baby gate in resident room #3 had been removed; however, the bathroom in room #3 still did not a non-slip mat and during today's visit care staff purchased non-slip mat and was placed on residents bathroom. A non-slip mat was observed in the shower of resident room #1. The baby monitor camera in resident room #2 had been removed. During the facility tour, LPA Lee observed R7 sleeping in staff room #4, which is not a licensed resident bedroom and is not approved for non-ambulatory residents. LPA Lee advised the administrator that resident R7 will need to be relocated to an approved resident bedroom in accordance with the facility’s fire clearance, as resident room #8 is vacant. LPA Lee was informed that R7 would be relocated to resident room #1, as resident R1 is not returning to the facility. LPA Lee advised the administrator that R1’s personal belongings remained in room #1 and instructed that the party responsible for R1 be contacted to inform them that the facility would gather and secure R1’s belongings in preparation for family retrieval, as the room would be occupied by another resident. LPA Lee observed that resident room #6 did not have a non-slip mat in the shower as well. Additionally, a Hoyer lift was observed blocking the emergency exit door leading to the backyard in resident room #6. The administrator removed the Hoyer lift during the visit. LPA Lee also observed that the emergency exit gate located on the right side of the facility has been removed; however, the exit door was not easily operable. Administrator stated that they will fix the gate. As a result of this continued post-licensing inspection, the facility was found to be out of compliance with California Code of Regulations, Title 22, and Health and Safety Code requirements. Deficiencies are documented on LIC 809-D and deficiencies cited during the initial post-licensing visit conducted on 12/12/2025. An exit interview was conducted with Administrator Mubeezi, and copies of LIC 809, LIC 809-D, and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Dec 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Dec 22, 2025

87468.1(a)(3) Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This was not met as evidenced by: The LPA Lee observed a chain and lock on the refrigerator and the pantry, which is an immediate health, safety or personal rights to persons in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: Both locks were removed during the visit. The licensee/administrator will conduct in-services training in regard to Personal rights of residents to include materials used for training, staff sign in sheet and a statement of acknowledgement of understanding and reviewing the regulation cited. POC due 12/22/2025 at the end of day 5:00 PM.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87207 · Plan of correction due date: Dec 22, 2025

87207 False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This was not met as evidenced by: During 12/12/2025 visit, both administrator and caregiver gave false statement in regard to R7 not being a resident but a grandmother or S1 who is babysitting S1’s son since the facility was over capacity by 1. This is immediate health, safety or personal rights to person in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: Both the administrator and care staff will review the regulation cited and a statement of acknowledgement of understanding and reviewing the regulation cited. POC due 12/22/2025 at the end of day 5:00 PM.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(d) · Plan of correction due date: Dec 22, 2025

87464(d) Basic Services (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This was not met as evidenced by: During LPA Lee’s visit on 12/12/2025, S1 was observed seated in staff room #4 supervising resident R7. S2 was observed sleeping in resident room #8, as S2 was assigned to the NOC shift. LPA Lee questioned the facility’s ability to provide adequate care and supervision to the remaining residents, as only one awake care staff member was on duty and was observed spending the majority of the visit in staff room #4 with the door closed while supervising R7 which raised concerns regarding who was providing care and supervision to the remaining residents during that time. This is immediate health, safety or personal rights to person in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: The licensee/administrator will conduct in-services training in regard to Basic Services to include materials used for training, staff sign-in sheet and a statement of acknowledgement of understanding and reviewing the regulation cited. POC due 12/22/2025 at the end of day 5:00 PM.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(4) · Plan of correction due date: Dec 22, 2025

87465(a)(4) Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This was not met as evidenced by: Based on record review and interviews, the Licensee did not comply with the section cited above. During 12/12/2025 visit, LPA Lee reviewed 2 out of 7 residents’ medication and it was learned that R7 had two medications that did not have a doctor's order to be administer to R7. R1 had 3 medications that were on hand; however, it was not documented in R1's CSMDR. This posed an immediate health and safety risk to R1.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: The licensee/administrator will conduct in-services training in regard to Incidental Medical and Dental Care to include materials used for training, staff sign-in sheet and a statement of acknowledgement of understanding and reviewing the regulation cited. POC due 12/22/2025 at the end of day 5:00 PM.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Dec 22, 2025

87468.2 (a)(1) Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This was not met as evidenced by: Based on observation and interview residents were not permitted a reasonable level of privacy in their private bedrooms since there was a camera in the resident’s room, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: Licensee agrees to provide a written acknowledgement that cameras or other audiovisual recording devices are not to be utilized in any resident rooms by POC due date 12/22/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(6) · Plan of correction due date: Dec 22, 2025

87468.1(a)(6) Personal Rights of Residents in All Facilities Type A (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above. LPA Lee observed resident in bedroom #3 had a gate on their door to prevent the resident from going out of their room to cause disturbances to other residents and from injuring themselves. Moreover, another resident was placed in staff room #4 with a gate installed by the door which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: The licensee/administrator will conduct in-services training in regard to Personal rights of residents in all facilities to include materials used for training, staff sign-in sheet and a statement of acknowledgement of understanding and reviewing the regulation cited. POC due 12/22/2025 at the end of day 5:00 PM.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2) · Plan of correction due date: Dec 29, 2025

87405(d)(2) Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Based on observation, record review and interviews, the licensee/administrator did not ensure to comply with regulations to ensure that the facility is within compliance and fire clearance are being followed which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: The licensee/administrator will conduct in-services training in regard to administrator qualifications to include materials used for training, staff sign-in sheet and a statement of acknowledgement of understanding and reviewing the regulation cited. POC due 12/29/2025 at the end of day 5:00 PM.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: Dec 29, 2025

87211(a)(1)(D) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below… (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews and record reviews, 2 residents went to the ER due to a fall and there was no incident report pertaining to the residents ER discharge records. Administrator admitted not completing any incident reports and submitting it to CCLD which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: Licensee agrees to send incident reports and to review the applicable 22 CCR sections regarding reporting requirements, and to send LPA Lee a statement acknowledging these requirements by POC due date 12/29/2025 end of day 5:00 PM.

Type of visit: Post Licensing

On 12/12/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility to conduct a Post-Licensing Visit. LPA met with care staff Linjey Peart, who notified the licensee/administrator, Violet Mubeezi, of LPA’s presence. Approximately 45 minutes later, Administrator Mubeezi arrived at the facility, and LPA explained the purpose of the visit. The census during this visit was seven residents, with one staff member on duty. The facility is a single-story building licensed to serve six (6) ambulatory residents, of whom six may be non-ambulatory, with a hospice waiver for four residents. LPA inspected the physical plant, including the common areas, kitchen, dining room, resident bedrooms, bathrooms, laundry room, garage, staff office, and outdoor courtyards to ensure compliance with Title 22 regulations. The facility was observed to be free of odors but unclean and not in good repair. Resident bedrooms were appropriately furnished with proper bedding and lighting. LPA observed the kitchen to contain a sufficient supply of food: a seven-day supply of non-perishables and a two-day supply of perishables; however, LPA observed a lock attached to the refrigerator and was informed by Staff 1 (S1) that the refrigerator is occasionally locked due to a resident who wanders and opens the refrigerator at night. Smoke and carbon monoxide detectors were in compliance, and fire extinguishers located in the kitchen, dining area, and hallway were last serviced on 09/26/2024. A public telephone was available in the common area and kitchen, and the required postings were present. The thermostat read 72°F, within the required range of 68–85°F. LPA observed unlocked and accessible toxins under the kitchen sink, as well as unlocked sharp knives in a kitchen cabinet. CONTINUED LIC 809-C Two of six resident bathrooms did not have non-slip mats, and the non-slip mat in bedroom #8 was observed to have mold. LPA also observed that the exit door from bedroom #6 to the rear emergency gate was obstructed by a metal frame, which the administrator removed during the visit. During the inspection, seven residents were present in care. During the facility tour with the administrator, LPA observed an individual lying in a bed in staff room #4, with S1 seated nearby supervising. When LPA inquired about the individual’s identity, the licensee/administrator stated that the person was S1’s grandmother, who visits the facility to help babysit S1’s son. When questioned about the diapers and clothing in the room, the administrator claimed they belonged to the grandmother and provided a name. Later in the visit, the individual exited the room, and LPA conducted an interview. It was determined that the individual was, in fact, a resident in care. Residents R6 and R7 were observed in bedroom #6. R1 and R3 were at the hospital, and R5 was out in the community. LPA observed the emergency gate on the right side of the facility locked with a padlock, and the emergency gate on the left side missing the required pull-string handle for the gate latch. LPA also observed a baby gate installed at the doorway of bedroom #3 to prevent the resident from leaving the room due to concerns about disturbing others or injuring themself. Additionally, a camera was observed on the dresser in bedroom #2, facing the resident’s bed, used for monitoring due to fall-risk behaviors. LPA will return at a later date to complete the post-licensing inspection. Based on today’s visit, the facility is not in compliance with Title 22 regulations. Deficiencies are documented on the LIC 809-D. An exit interview was conducted with Administrator Mubeezi, and copies of the LIC 809, LIC 809-D, and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Dec 12, 2025

Type of visit: Prelicensing

On 01/23/25 at 8:30 AM Licensing Program Analyst (LPA) Pang Lee arrived announced to conduct a Pre-Licensing follow-up inspection of the facility to ensure compliance with Title 22 regulations. LPA Lee met with applicant Violet Mubeezi who assisted LPA in today’s inspection. LPA Lee toured the facility with the applicant. During today's visit, LPA observed the green house in the courtyard being used as a storage. LPA Lee observed miscellaneous items in the in the green house and it was observed to be locked. Per applicant resident will not have access to the green house. LPA Lee did advise the applicant to clean out the green house. Applicant stated that she will have the greenhouse clean by end of day 01/27/25 and send LPA Lee pictures via email. LPA Lee observed the following corrections were completed: · A plan of operation to include the 4 cameras in the facility was submitted on 01/14/25 to centralized applications bureau (CAB) for review. · Licensee updated facility sketch to include the four cameras in the facility, laundry room and designated office. · Licensee removed personal belongings in residents’ bedrooms. · Resident bedrooms are equipped with drawers and a chair. · Observed all residents’ bathrooms showers have non-slip mats and grab bars and are sturdy. · Observed the cabinet in the kitchen where the knifes are store and the cabinet in resident bathroom 3 are in good repair. Continued LIC 809-C · Observed rolled carpets, mattress, bedframes, boards, miscellaneous items in resident bedrooms are remove. · Complaint poster PUB 475 in the size of 20”X26” is posted in the entry of the facility. · The crawl space on the side of the facility is made inaccessible to residents in care. · The exposed wires, wood planks and miscellaneous items in the courtyard and garage was disposed. · The facility has sufficient 2 days perishable food at all times. · A rail was installed in the back porch to prevent residents from falling over. LPA reviewed Component 3 with the applicant. The applicant has passed the pre-licensing component of the application process. LPA will notify the CAB that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was given to the applicant.the state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Prelicensing

On 01/09/25, at 1:00 PM, Licensing Program Analyst (LPA) Pang Lee arrived announced to conduct a Pre-Licensing Inspection of the facility to assess compliance with Title 22 regulations. LPA Lee met with Licensee Violet Mubeezi who assisted during the inspection. The applicant is seeking licensure for a 6-bed non-ambulatory Residential Care Facility for the Elderly (RCFE), which will accept and retain residents, including bedridden individuals. Bedrooms 1, 2, 3, 6, 7, and 8 are designated for non-ambulatory residents, while bedrooms 4 and 5 are designated for staff rooms. The facility also has a dementia care plan on file. The facility will provide 24/7 care and supervision, with live-in staff. At the time of the inspection, there were no residents present. A brief interview was conducted with the applicant. Violet Mubeezi will be the Administrator of the facility. Her administrator’s certificate #7034316740 is valid until 09/09/25. The facility has an infection control plan and an emergency disaster plan, both of which have been submitted to Licensing for approval. LPA Lee toured the facility with the applicant and noted the presence of 4 cameras throughout the premises. However, these cameras were not included in the facility's sketch and plan of operation. Additionally, the facility’s physical layout did not match the submitted sketch, as there are rooms designated for laundry and staff office that were not accounted for in the submitted facility sketch. LPA Lee also observed several picture frames stored behind a sofa in the entrance area. During the kitchen inspection, LPA Lee reviewed the cabinets and drawers. The facility had sufficient silverware, plates, and utensils for the residents. Knives, cleaning agents, and bleach were properly secured and inaccessible to residents. However, the cabinet where knives were stored was in disrepair. The food storage area, including the facility's refrigerator, was functional and in good condition. Continued LIC 809-C However, there was insufficient 2 days perishable food supplies, as only condiments, a loaf of bread, and a dozen eggs were present in the refrigerator. The common and dining areas were appropriately furnished to meet the needs of residents. A telephone was available in both the kitchen and common area for resident use. The facility’s smoke detectors, carbon monoxide detectors, and fire extinguisher were all in good condition. The fire extinguisher had been serviced on 09/26/24. LPA Lee did not observe a linen closet or designated storage for linens. Some linens and blankets were stored in trash bags and laundry baskets in multiple residents’ rooms. Additionally, several residents' rooms did not have sufficient furniture, such as chairs and drawers, to meet residents’ needs. The bathrooms in the residents' rooms did not have non-slip mats and grab bars. LPA Lee also observed staff personal belongings in resident rooms #6 and #8. The water temperature was measured at 112.5°F, and the facility temperature was recorded at 73°F which are withing the required regulation. The centrally stored medication areas were locked, and the first aid kit was complete. Hygiene items were available for residents, and there was a designated area for both resident and staff files. LPA Lee did not observe the required complaint poster (PUB 475) displayed in the facility. Activity supplies for residents were available. LPA Lee also toured the garage, where miscellaneous items were stored. The administrator was advised that the cluttered area would need to be cleaned up and decluttered. In the outdoor areas, LPA Lee noted the presence of various items, such as a broken microwave, picture frames, wood planks, a broken window screen, bedrails, racks, and shovels, in the courtyard. Additionally, exposed wire was observed on the backyard porch, along with sharp metal attached to the fence. While the emergency exits were unobstructed, the back porch posed a health and safety concern, as it was 22 inches high and lacked rails to prevent residents from falling. Furthermore, there was an accessible crawl space on the side of the facility, which could present a safety risk to residents. The applicant will work on the following deficiencies observed: · Licensee will ensure that an updated plan of operation to include the 4 cameras in the facility. A plan of operation will also be submitted to include the purpose of the camera, who can view the camera, how long is the recording and that the camera can NOT have audio. Continued LIC 809-C · Licensee will ensure that an updated facility sketch to include the laundry room and designated office. · Licensee will ensure that personal belongings in residents’ bedrooms are removed. · Licensee will ensure that resident’s room are equipped with drawers and a chair. · Licensee will ensure that all residents bathrooms showers have non-slip mats and grab bars. · Licensee will ensure that the cabinet in the kitchen where the knifes are store and the cabinet in resident bathroom 3 are in good repair. · Licensee will ensure that rolled carpets, mattress, bedframes, boards, miscellaneous items in resident bedrooms are remove. · Licensee will ensure that a complaint poster PUB 475 in the size of 20”X26” is posted. · Licensee will ensure the crawl space on the side of the facility is made inaccessible to residents in care. · Licensee will ensure that all the exposed wires, wood planks and miscellaneous items in the courtyard are disposed. · Licensee will endure that the facility has sufficient 2 days perishable food at all times. · Licensee will ensure that there is a rail install in the back porch to prevent residents from falling over. The Applicant has not passed the pre-licensing component of the application process. The applicant will correct deficiencies and inform LPA Lee when the corrections have been completed. An exit interview was conducted, and a copy of this report was provided to the applicant.the state’s words, verbatim · CDSS document, Jan 9, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity:6 Census (if any clients in care): 0 COMP II Participants: Violet Mubeezi (applicant/licensee, administrator) Interview Method: Telephone interview On 12/17/24, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Dec 17, 2024

Allegation investigated: Unlicensed Care

Licensing Program Analysts (LPAs) Vincent Moleski, Holly Williams, and Kevin Gould arrived unannounced to open this complaint investigation. The LPAs met with operator Violet Mubeezi and explained the purpose of the visit. Mubeezi currently has an application pending with the Central Applications Bureau for a license to care for elderly residents. LPAs Moleski and Williams toured the property and observed no currently residents in care. In an interview, Mubeezi said that she has been caring for one resident (R1), who is currently at the hospital. Mubeezi said that R1 has been receiving services since moving in on 10/4/24. According to Mubeezi, these services include assistance with medication, the central storing of medications, assistance with meal service, assistance with showers, assistance with making medical appointments, supervision, and maintenance of R1's restricted diet. Mubeezi said that R1 does not have any cash resources stored at the property. [continued on 9099-C] Substantiated LPA Moleski interviewed a staff member present at the property upon arrival (S1). S1 said that R1 has been living at this property for approximately two to three weeks. S1 said they provide assistance to R1 with meals, showers, medications, arranging medical care, and maintenance of R1's restricted diet. R1 was sent to the hospital on Saturday October 26, 2024, according to Mubeezi. S1 said they had called emergency medical services on that date because S1 was experiencing weakness and shortness of breath. LPA Moleski observed R1's room to contain various personal belongings. LPA Moleski observed R1's medications were being kept in a locked cabinet in the kitchen. LPA Moleski reviewed R1's file, which contained an admission agreement for Residential Care Facilities for the Elderly. The admission agreement contained provisions for basic services as defined by Title 22 of the California Code of Regulations. R1's file contained an LIC 602, Physician's Report for Residential Care Facilities for the Elderly. R1's file also contained various medical records from R1's previous placement. The department has determined the following as it relates to the allegation that unlicensed care is being provided. Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met. A notice of violation of law was issued to Mubeezi. An exit interview was held with Mubeezi. Appeal rights and a copy of this report were left with Mubeezi.the state’s words, verbatim · CDSS document, Oct 29, 2024 · control 27-AS-20241023150308