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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290817
Report Date: 07/01/2024
Date Signed: 07/01/2024 12:02:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240313093223
FACILITY NAME:ROSEWOOD HOMEFACILITY NUMBER:
191290817
ADMINISTRATOR:ROSEMARIE F. DECENARIOFACILITY TYPE:
740
ADDRESS:9645 FULLBRIGHT AVENUETELEPHONE:
(818) 993-9719
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 5DATE:
07/01/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Rosemarie DecenarioTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Staff did not assist residents with oral hygiene.
Staff did not notice change in residents’ condition.
INVESTIGATION FINDINGS:
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On 07/01/2024 at 11:15 am Licensing Program Analyst (LPA), Lorena Casillas conducted a subsequent unannounced complaint visit to investigate the above stated allegations. LPA met with Administrator Rosemarie Decenario and explained the reason for the visit.

At 11:30 AM LPA Casillas conducted a physical plant tour. On 03/18/2024 LPA had previously requested resident roster, Liability Insurance, Bond, LIC 500 and copies of pertinent information relevant to the investigation including but not limited to resident records, and any other information pertaining to the investigation, therefore these items were not collected on this visit.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20240313093223
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROSEWOOD HOME
FACILITY NUMBER: 191290817
VISIT DATE: 07/01/2024
NARRATIVE
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Allegation #1 Staff did not assist residents with oral hygiene.

It is alleged that staff did not assist residents with oral hygiene. Regarding this allegation it is reported that Resident #1 (R1) was not assisted with maintaining oral hygiene. LPA interviewed the Administrator, and it was revealed that oral hygiene is performed on all residents that need assistance. Upon interviews with staff and residents it was revealed that not all residents require help, however when they are independent, staff constantly remind residents to self groom. When residents are not independent staff will perform grooming, including oral hygiene for them. Administrator and staff also stated that when residents need help, they are constantly helping with any needs that residents have. Furthermore, staff and Administrator were able to produce pictures of R1 and constant communication with R1’s family to show progress. Based on record review, interviews and observations, this allegation is Unsubstantiated at this time.

Allegation #2 Staff did not notice change in residents’ condition.

It is alleged that staff did not notice change in residents’ condition. Regarding this allegation it is reported that staff failed to recognize that R1 had Covid19. LPA interviewed the Administrator, and it was discovered that staff and residents had no symptoms of Covid or any flu like symptoms at the time when R1 was discovered by the hospital to have Covid 19. Administrator furnished temperature logs taken daily for residents where no spike in temperatures was recorded. Administrator also furnished resident medical updates where changes are constantly recorded however none of the changes recorded pertain to flu like or Covid symptoms. Furthermore, Administrator was able to provide LPA with proof of negative Covid 19 tests taken by all staff and all residents during the time that R1 was taken to the hospital also, Administrator provided proof of repeat negative Covid19 tests taken 48 hours after initial Covid19 test. Based on interviews, record reviews and observations this allegation is Unsubstantiated at this time.

No citations issued. Copy of this report given to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2