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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 05/16/2025
Date Signed: 05/16/2025 02:33:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/29/2023 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20231229131955
FACILITY NAME:ROSE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
366426422
ADMINISTRATOR:DANICA TURNERFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:63CENSUS: 57DATE:
05/16/2025
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Schamone Bard, Executive DirectorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
The facility is violating the approved fire capacity.
Staff is mismanaging residents medications.
Resident's care needs are not being met.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/16/2025 at 12:10 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Serrano met with Executive Director Schamone Bard to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staffs and residents as well as facility observation.

Allegation #1: The facility is violating the approved fire capacity. – Based on observation, interview and file review, the facility never goes over the capacity of 63 residents. Based on the interview with Staff #1 (S1) the maximum residents that the facility ever had was 56 in total. Information received during the investigation; LPA was unable to corroborate the allegation

*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
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-20231229131955
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ROSE GARDEN RESIDENTIAL CARE
FACILITY NUMBER: 366426422
VISIT DATE: 05/16/2025
NARRATIVE
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Allegation #2: Staff is mismanaging residents medications. - Based on interviews, 3 out 3 residents stated that they are getting their medications on time and does not know any staff that was mismanaging any medication. Based on record review of their electronic medication administration record (EMAR), LPA observed that the medications were administered on time and no issues. Information received during the investigation: LPA was unable to corroborate the allegation.

Allegation #3 Resident's care needs are not being met. - Based on interviews, 3 out of 3 residents stated that their care needs are being met, and they are being treated well. information received during the investigation did not corroborate with the allegation. Additional interviews with witnesses and the alleged victim were unable to be conducted at this time due to unavailability.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Executive Director Schamone Bard.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
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