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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 08/23/2021
Date Signed: 08/23/2021 01:56:47 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, 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
08/20/2021 and conducted by Evaluator Anna Bueno
COMPLAINT CONTROL NUMBER: 18-AS-20210820153948
FACILITY NAME:ROSE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
366426422
ADMINISTRATOR:PENDINGFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:63CENSUS: 53DATE:
08/23/2021
UNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Morgan Williams, AdministratorTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Facility phone is in disrepair.
Facility staff not allowing family visitation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to investigate the above allegations. LPA met with Administrator Morgan Williams and Cindell Garham, Wellness Director.

LPA toured the facility, conducted interview, and made pertinent observations. The first allegation indicates that the facility phone is in disrepair. LPAa was informed that the facility had a brief intermittent phone and wifi issues while their communications provider tested equipment in the facility. LPA observed four answered calls made to the facility during today's visit. The second allegation indicates that the staff was not allowing family visitations. LPA observed an ongoing outdoor visit with a resident and LPA observed a resident on their way to an outing. LPA also observed a visitation appointment book with appointments from Agust 2020

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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 18-AS-20210820153948
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: 08/23/2021
NARRATIVE
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No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator William.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2