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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426422
Report Date: 03/25/2022
Date Signed: 03/25/2022 02:50:37 PM

Document Has Been Signed on 03/25/2022 02:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
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:
03/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Morgan WilliamsTIME COMPLETED:
02:55 PM
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Licensing Program Analysts (LPA) Anna Bueno and Rayshaun Nickolas conducted an unannounced visit to the facility to conduct additional interviews and gather documents pertinent to complaint control number 18-AS-20210127131000. LPAs were met by executive director, Morgan Williams.

LPAs toured the facility and conducted resident and staff interviews. During this visit, LPAs did not observe imminent health & safety concerns.

Ms. Williams was advised that the investigation is still open. Additional time is needed to complete this investigation.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to Ms. Williams.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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