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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 08/30/2021
Date Signed: 11/24/2021 12:57:48 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
08/25/2021 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210825144027
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: 54DATE:
08/30/2021
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Morgan WilliamsTIME COMPLETED:
03:58 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff improperly restrained resident.
Facility staff yelled at resident.
Facility is not kept clean.
Facility staff are not safeguarding resident's personal property.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Anna Bueno and Bernadette Allen conducted a complaint visit to deliver findings on the above allegations. LPAs met with Executive Director (ED), Morgan Williams and Cindell Graham, Wellness Director. LPA Bueno conducted the initial investigation and interviewed staff and resident and reviewed facility files.

The first and second allegations state that Resident 1 (R1) was was improperly restrained and yelled at by staff. Interviews with staff and resident revealed that R1 is combative when being changed. Interviews also confirmed that there is always at least two care staff assisting in changing R1 because they would complain of pain when being changed. The third allegation is that the facility is not kept clean. LPA toured the facility and viewed several resident rooms in all three buildings. Through interviews and observations, LPA determined that cleaning supplies are accessible to staff in all shifts and housekeeping is conducted daily in common rooms and weekly rotational for the apartments.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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-20210825144027
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: 08/30/2021
NARRATIVE
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5
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9
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21
22
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32
The last allegation is that the facility is not safeguarding resident's personal property. LPA visited the laundry area and inspected clothing items that were found to have names on them. Interview with staff revealed that the facility also accepts donated clothing from family of resident's that have left the facility. LPA also observed residents on multiple occasion to have removed and forgotten their shoes and/or socks.

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.

An exit interview was conducted where this report was discussed and provided to Executive Director, Morgan Williams.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2