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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 11/24/2021
Date Signed: 11/24/2021 01:00:19 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: 58DATE:
11/24/2021
UNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Morgan Williams TIME COMPLETED:
01:06 PM
ALLEGATION(S):
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Facility staff did not report an incident as required.
Facility staff did not prevent residents from engaging in a physical altercation.
Facility staff are camouflaging resident's medications without a prescription.
Facility has scabies.
INVESTIGATION FINDINGS:
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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 reviewed facility files.

The first complaint alleges that staff do not report incidents as required. Community Care Licensing regional office has been receiving and recording incident reports from the facility consistently. The second complaint alleges that staff did not prevent residents from engaging in a physical altercation. Per observations and interviews, staff are always present in areas where residents congregate and attend to a resident when flagged or when resident asks for assistance. The third complaint alleges that resident medication
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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: 11/24/2021
NARRATIVE
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are camouflaged without prescription. LPA reviewed medication records and was not able to find enough evidence that the incident did or did not occur. The last complaint alleges that the facility has scabies. Interviews revealed that a resident is suspected to have scabies however review of documents show that a physician inspected the suspected resident and gave a different diagnosis causing itching.

These allegations are therefore unsubstantiated. 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: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2