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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003448
Report Date: 07/10/2025
Date Signed: 07/11/2025 08:16:32 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/03/2025 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250703160418
FACILITY NAME:FULLERTON ROSEWOOD ASSISTED LIVINGFACILITY NUMBER:
306003448
ADMINISTRATOR:JANE KIMFACILITY TYPE:
740
ADDRESS:411 E. COMMONWEALTH AVENUETELEPHONE:
(714) 441-0644
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY:99CENSUS: 53DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator Jane KimTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not maintain facility floors free of debris
INVESTIGATION FINDINGS:
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On July 10, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the above listed allegation. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Jane Kim was notified via telephone and later arrived to assist with the inspection.

The facility is a two story building with resident bedrooms located on the first floor and second floor. The facility also has additional common areas that include a lobby area, a dining room, a courtyard, and a lounge room. On today's visit, LPA collected pertinent documents such as current resident roster, the current staff roster, and resident records. LPA also conducted six resident interviews and five staff interviews. Additionally, LPA, accompanied by the AD, conducted a tour of the physical plant. LPA inspected six resident bedrooms, which include resident bedrooms on the first and second floor, and observed them to be clean and free of any debris. CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 22-AS-20250703160418
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: FULLERTON ROSEWOOD ASSISTED LIVING
FACILITY NUMBER: 306003448
VISIT DATE: 07/10/2025
NARRATIVE
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LPA also inspected all common areas including the lobby, dining room, courtyard, and lounge room which were observed to be clean and free of any debris. LPA additionally inspected each resident hallway on both the first and second floor and observed them to be clean and free of debris. Resident hallways were free of any hazards and are maintained in good repair. Six out of six residents interviewed stated the facility is maintained in a clean manner and denied observing any debris on the facility floors. Five out of five staff interviewed also denied observing any debris on the facility floors.

Based on the evidence gathered during the investigation, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator (AD) Jane Kim and a copy of the report was provided.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
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