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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005575
Report Date: 04/16/2026
Date Signed: 04/16/2026 12:05:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/06/2026 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20260406164008
FACILITY NAME:ROSE GARDEN VILLAFACILITY NUMBER:
306005575
ADMINISTRATOR:OLTEANU, CLAUDIAFACILITY TYPE:
740
ADDRESS:2210 W AVALON AVETELEPHONE:
(949) 232-9619
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:6CENSUS: 5DATE:
04/16/2026
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Mylene ManzeTIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Staff are not providing appropriate transportation for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA interviewed staff as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegation that staff are not providing appropriate transportation for residents, the investigation revealed the following: On 04/03/2026 Resident 1 (R1) was transported to Foothill Regional Hospital in Tustin after appearing weak. Resident had gone to two medical appointments earlier in the day and returned tired and weak. Administrator states checking the resident's oxygen saturation levels which were fluctuating between 87-95. Administrator took R1's blood pressure which was reading 92/69. Administrator and staff confirm the resident was talking and conscious before being transported to the hospital in the facility van. Both confirm resident's color was good and did not appear to be in stress. Resident was admitted for a urinary tract infection CONTINUED ON LIC 9099C DATED 04/16/2026
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
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 22-AS-20260406164008
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROSE GARDEN VILLA
FACILITY NUMBER: 306005575
VISIT DATE: 04/16/2026
NARRATIVE
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and sepsis and was subsequently transferred to a skilled nursing for recovery. Facility self reported the incident to the department on 04/10/2026. Administrator indicates being aware of the need for 911 calls in emergency situations and LPA provided PIN 25-06-ASC for reference regarding 911 calls. Based on interviews conducted and record review, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2