306003448-1-8-2026-22-AS-APAO-DRWU3X-20260306141415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003448
Report Date: 01/08/2026
Date Signed: 01/08/2026 03:39:15 PM

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
01/02/2026 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260102163909

FACILITY NAME:	FULLERTON ROSEWOOD ASSISTED LIVING		FACILITY NUMBER:	306003448
ADMINISTRATOR:	JANE KIM		FACILITY TYPE:	740
ADDRESS:	411 E. COMMONWEALTH AVENUE		TELEPHONE:	(714) 441-0644
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92832
CAPACITY:	99	CENSUS: 49	DATE:	01/08/2026
		UNANNOUNCED	TIME BEGAN:	07:12 AM
MET WITH:	Administrator Jane Kim		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not keep resident's informaiton confidential.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit on an investigation competed by the Department. LPA Tirre was greeted and granted entry by staff and explained reason for visit. LPA met with Administrator Jane Kim.
During the course of investigation, the Department conducted interviews and reviewed documents. The investigation conducted revealed the following:
On January 2, 2026 the department received a complaint alleging that staff did not keep residents’ information confidential. Department conducted interviews with staff, residents and witness.
Interviews with staff revealed that five Five of five staff state that they have not witnessed other staff giving out personal information of residents. Three of five staff stated they contact either Physician or responsible parties if additional medical information is to be obtained on behalf of residents care such as updated medication lists, clarification of Doctors orders, discharge paperwork, change of condition or other medical related information. Five of five staff have stated they have not given out confidential information regarding
continued on 9099C

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

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-20260102163909

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: 01/08/2026

NARRATIVE

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residents or residents files. Staff stated that information obtained is handled privately.
Interview with Witness, revealed that they have not experienced any facility staff sharing confidential resident information without consent.

Interview with Resident 1, stated that Staff1 had contacted Physician without consent or knowledge.

Records reviewed revealed that Resident 1’s Admission Agreement was signed and reviewed with responsible party. Responsible party initialed acknowledging they received Resident Rights stating resident or responsible party have the right to make decisions about medical treatment and advanced health care directive. Record review revealed that Responsible party signed consent for “ emergency medical treatment stating they give Fullerton Rosewood Assisted Living consent to provide all emergency medical or dental care prescribed by licensed physician for Resident 1, stating this care may be given under whatever conditions are necessary to preserve the well being of the individual named".

During investigation, LPA observed resident records are in a secure location and not accessible to public.

Due to the information provided in investigation, the preponderance of evidence was not met. The allegation Staff did not keep resident's information confidential is deemed UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred as reported.

An exit interview was conducted with Administrator Jane Kim and a copy of this report was provided to the facility.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

LIC9099 (FAS) - (06/04)

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