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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 07/23/2021
Date Signed: 07/23/2021 03:15:28 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2021 and conducted by Evaluator Elecia Weathersby
COMPLAINT CONTROL NUMBER: 18-AS-20210415154729
FACILITY NAME:ROSE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
366426422
ADMINISTRATOR:TONY RIOSFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:63CENSUS: 52DATE:
07/23/2021
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Administrator, Morgan WilliamsTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have sufficient staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elecia Weathersby made an unannounced visit to initiate a complaint investigation for the above allegations. LPA met with Administrator Morgan Williams to discuss complaint investigation and deliver findings.

Allegation #1 - Facility does not have sufficient staff
The investigation consisted of facility inspection, interviews with facility administrator, and review of facility records. LPA obtained copies of pertinent documents. It was revealed that there is a sufficient number of qualified staff to meet the needs of the residents in care, for all shifts.

This agency has investigated the complaint allegation. We have found that the preponderance of evidence standard was not met, therefore the above allegation is UNSUBSTANTIATED. A finding of Unsubstantiated means 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.

An exit interview was conducted and a copy of this report and LIC 811 are being reviewed with and provided to Administrator - Morgan Williams at the end of the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Elecia Weathersby
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
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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