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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 01/27/2023
Date Signed: 01/27/2023 09:07:54 AM

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
08/24/2022 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20220824151817
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:
01/27/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Morgan Williams-Administrator TIME COMPLETED:
09:15 AM
ALLEGATION(S):
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Resident sustained injuries while in care.
Facility not safeguarding residents’ belongings.
Facility staff not providing adequate hygiene services.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate an investigation and deliver finding for the allegations listed above. LPA Allen met with Morgan Williams and explained the reason for the visit.

During the investigation One (1) Resident and Two (2) staff members were interviewed. (R1) was asked about sustaining injuries while at the facility by someone or something and resident (1) said they had not been hurt by anything or anyone while at the facility. (R1) was asked about their personal belonging and (R1) said that they have what they need. During the investigation LPA Allen did observe personal hygiene items and clothing items in (R1's) room as well as the required furniture was which appeared in good condition.
Based on documenst reviewed the resident is capable of handling their personal hygiene needs and when (R1) was asked about their hygeine needs it was said that they can shower whenever they want to shower.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
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-20220824151817
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: 01/27/2023
NARRATIVE
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The interviews with staff (S1) and staff (S2) said that residents in care are encouraged and informed of the benefits of hygiene but the residents are never forced to engage in grooming needs.

Based on the observations, documents reviewed and interviews the allegations listed above have been found as 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 where a copy of this report with the appeal rights were provided to Morgan Williams at the conclusion of the visit.

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

DATE: 01/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2