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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 11/16/2022
Date Signed: 11/16/2022 05:23:03 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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2022 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20221108110403
FACILITY NAME:ROSE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
366426422
ADMINISTRATOR:MORGAN E. WILLIAMSFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:63CENSUS: 61DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Morgan Williams Administrator TIME COMPLETED:
05:45 PM
ALLEGATION(S):
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9
Medication not being dispensed to resident
Denied entry to visit resident
Resident not assisted with ADLs
INVESTIGATION FINDINGS:
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9
10
11
12
13
Licensing Program Analysts (LPA) Bernadette Allen arrived at the facility unannounced to conduct a complaint investigation and deliver the findings for the allegation(s) listed above. LPA met with Morgan Williams Administrator.
During visit LPA Allen, conducted interviews and record reviews and found the following

Allegation #1- Medication not being dispensed to resident. LPA, Allen conducted interviews with three (3) staff members and reviewed resident(s) files and LPA found that medications were being dispensed to the resident(s) in care.

Allegation #2- Denied entry to visit resident. LPA Allen interviewed outside party(s) and three (3) staff members and LPA found that the resident(s) visitor(s) were not denied entry into the facility.

Allegation #3- Resident not assisted with ADLs. LPA Allen reviewed file(s) and R#1 handles their own ADL's and does not need care and supervision.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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 56-AS-20221108110403
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
, CA 92507
FACILITY NAME: ROSE GARDEN RESIDENTIAL CARE
FACILITY NUMBER: 366426422
VISIT DATE: 11/16/2022
NARRATIVE
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Based on interviews conducted, and record review the three (3) allegations listed above are deemed Unsubstantiated. A finding that a complaint is Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
An exit interview was conducted, and this report and appeal rights was discussed and provided to Morgan Williams Administrator at the conclusion of the visit
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2