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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 11/16/2023
Date Signed: 11/16/2023 02:54:15 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
11/15/2023 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20231115085745
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: 56DATE:
11/16/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Leilani Cortez Wellness DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff left resident soiled for an extended period of time.
Staff does not provide adequate supervision to residents in care.
Staff did not ensure resident's hygiene needs were being met.
Staff did not provide resident with clean clothing.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the mentioned allegations. LPA Allen met with Leilani Cortez Wellness Director who was informed of the purpose of the visit and allegations.

LPA Allen conducted interviews with staff members, Resident 1 (R1), outside parties and documents were reviewed.
The interviews conducted with staff members stated that residents are check on every two (2) hours or as needed. Staff has also stated R1 could use the restroom as needed but had to be encouraged allowing staff to check their undergarments due to incontinence. Staff also stated they have not experienced any resident being soiled for an extended period. Records were reviewed and it appeared that there is adequate staff to meet the needs of the residents. Records reviewed also shows residents hygiene needs are met daily or as needed. During the visit LPA observed residents in care clothing to be free of stains, odors and their hygiene needs appeared to be met.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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-20231115085745
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: 11/16/2023
NARRATIVE
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The interviews with outside parties and R1 stated that their hygiene needs were met, and help was provided when needed.

Based on records reviewed, observations and interviews with staff, R1 and outside parties, the above finding 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 where this report was discussed and provided to Leilani Cortez- Wellness Director at the conclusion of the visit with appeal rights.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2