366426422-7-6-2023-18-AS-JDHS-CU2UJC-20230724153720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 07/23/2021
Date Signed: 07/06/2023 05:59:20 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
07/14/2021 and conducted by Evaluator Elecia Weathersby

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210714112954

FACILITY NAME:	ROSE GARDEN RESIDENTIAL CARE		FACILITY NUMBER:	366426422
ADMINISTRATOR:	PENDING		FACILITY TYPE:	740
ADDRESS:	1350 WABASH AVE.		TELEPHONE:	(909) 794-1040
CITY:	MENTONE	STATE: CA	ZIP CODE:	92359
CAPACITY:	63	CENSUS: 52	DATE:	07/23/2021
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Administrator, Morgan Williams		TIME COMPLETED:	03:12 PM

ALLEGATION(S):

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Staff failed to contact authorized representative in a timely manner.
Facility not safeguarding residents’ belongings.
Resident room not being cleaned.
Due to staff neglect resident was in an altercation with another resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Martinez conducted a visit to deliver an amended report of previous findings delivered by LPA Elecia Weathersby. LPA Weathersby conducted an investigation of the above stated allegations. During the investigation LPA Weathersby met with Administrator Morgan Williams, conducted interviews with staff, Resident 1 (R1), other pertinent witnesses and conducted a review of facility records.

Allegation #1 - Staff failed to contact authorized representative in a timely manner.
LPA Weathersby reviewed records, conducted interviews with staff, resident 1 (R1) and confidential witness. It was alleged that the responsible party was not notified of R1's diagnosis. Administrator Williams stated R1’s responsible party had been notified of the diagnosis. LPA was unable to corroborate or refute the allegation.

Allegation #2 - Facility not safeguarding residents’ belongings.
LPA Weathersby conducted interviews with staff, (R1) and confidential witness. It was alleged that clothing, a

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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 18-AS-20210714112954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROSE GARDEN RESIDENTIAL CARE	FACILITY NUMBER: 366426422
	VISIT DATE: 07/23/2021

NARRATIVE

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tablet, and a cell phone were missing. A confidential witness reported seeing another resident wearing R1’s clothing. R1 denied that any personal belongings were ever missing. Staff also denied any awareness that R1’s personal items were missing. Staff did confirm that it was reported to them that there were items missing. Staff were unable to verify missing items. LPA was unable to corroborate or refute the allegation of staff not safeguarding resident’s belongings.

Allegation #3 - Resident room not being cleaned.

LPA Weathersby conducted interviews with staff, (R1) and confidential witness. It was alleged that R1's room was observed to be messy. Staff and R1 both report the bedroom was being cleaned. LPA also obtained cleaning logs which reflect regular room cleaning dates. LPA could neither corroborate nor refute the allegation that resident’s room was not being cleaned.

Allegation #4 – Due to staff neglect resident was in an altercation with another resident.

LPA Weathersby conducted interviews with staff, (R1) and confidential witness and reviewed R1’s facility progress notes. It was alleged R1 was assaulted several times by other residents. Details on dates and names of residents could not be provided. R1 denied ever being in any altercation with other residents. Staff interviewed denied any resident altercation. LPA did not find evidence to corroborate nor refute the allegation that resident was in an altercation with another resident due to staff neglect.

Based on interviews with R1, staff and a review of facility documentation the allegations are UNSUBSTANTIATED. A finding that the complaints are unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the allegations occurred.

An exit interview was conducted, and a copy of this report was reviewed with and provided to Mercedes Trujillo, Business Office Manager (BOM).

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

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