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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 01/25/2023
Date Signed: 01/25/2023 02:08:13 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
01/18/2023 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20230118111439
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: 57DATE:
01/25/2023
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Morgan Williams Administrator TIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Resident in care sustained unexplained bruises
Staff do not prevent altercations between residents
Staff are not following proper reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bernadette Allen an conducted an unannounced visit to initiate and deliver findings for the allegations above. LPA Allen met with Morgan Williams who was informed of the purpose of the visit.

During LPA Allen investigation, LPA interviewed five (5) staff member and five (5) residents. LPA Allen interviewed (R1) who said that they don’t have bruising on their body and that they don't have any problems with people. LPA also observed documentation that shows staff members have been documenting when bruising occurs on the residents. The interviews conducted with the five (5) staff members said that there are times when confrontations occur with residents and they are redirected and one on one staff supervision is put in place if needed.

Documents were reviewed and staff are taking precautions to prevent altercations between residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
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-20230118111439
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: 01/25/2023
NARRATIVE
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Documents also reflect that staff members have current training in redirecting residents LPA Allen also reviewed documentation that shows staff are following reporting requirements.

Based on observations, interviews and documentation the allegation findings is Unsubstantiated. A finding of unsubstantiated means although the allegations 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 a copy the report was provided with appeal rights to Morgan Matthews at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2