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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426422
Report Date: 09/06/2022
Date Signed: 09/06/2022 04:49:41 PM

Document Has Been Signed on 09/06/2022 04:49 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:RFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY: 63CENSUS: 57DATE:
09/06/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:14 PM
MET WITH:Mercedes “Christina” Trujillo-Business Office Manager TIME COMPLETED:
04:59 PM
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Licensing Program Analysts (LPAs) Ryan Gardner and Bernadette Allen made an unannounced visit to conduct a Health and Safety check of the clients in care at the facility. LPA Gardner met with Business Office Manager Mercedes “Christina” Trujillo and explained the reason for the visit.

The Health and Safety check included an overall observation of the facility inside, and outside, including food supply, physical plant, and the clients in care. LPA Gardner interviewed staff and clients in care. LPAs observed the facility to be controlled by the air conditioner at 81 degrees Fahrenheit. LPAs observed shaded sitting areas outside for the residents. The facility has the required amount of food and water supply for the residents in care.

LPAs did not observe any safety hazards. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Business Office Manager Mercedes “Christina” Trujillo.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
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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