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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 04/15/2026
Date Signed: 04/16/2026 08:19:59 AM

Substantiated


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
06/16/2021 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20210616115655
FACILITY NAME:ROSE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
366426422
ADMINISTRATOR:PENDINGFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:63CENSUS: 49DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Executive Director Melissa Buckridge TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Resident sustained fractures while in care
INVESTIGATION FINDINGS:
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On 4/15/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering the complaint investigative findings into the allegation listed above. LPA Flores met with Executive Director Melissa Buckridge, and explained the purpose of the visit. The investigation is summarized as follows:

Information received alleged Resident #1 (R1) sustained fractures while in care. An interview conducted with Staff #1 (S1) reports that R1 eloped from the facility some time after 10PM when R1 was last seen. Staff at the facility were unaware of R1’s absence until Law Enforcement arrived at approximately 1:00 AM the following morning requesting if R1 was currently residing at the licensed facility. S1 was made aware of the incident by staff at the facility. Interviews with Staff #2 (S2) and Staff #3 (S3) corroborate S1’s account, reporting that staff were made of R1’s elopement as a deputy from the local Law Enforcement arrived at the facility to confirm if R1 was residing at the facility.
(Continue to LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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 5
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
06/16/2021 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20210616115655

FACILITY NAME:ROSE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
366426422
ADMINISTRATOR:PENDINGFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:63CENSUS: 49DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Executive Director Melissa Buckridge TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Illegal eviction
INVESTIGATION FINDINGS:
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On 4/15/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering the complaint investigative findings into the allegation listed above. LPA Flores met with Executive Director Melissa Buckridge, and explained the purpose of the visit. The investigation is summarized as follows:

Information received alleged Resident #1 (R1) was unlawfully evicted from the facility. An interview conducted with Staff #1 (S1) reported that R1 was new to the facility when the elopement incident occurred. When R1 was placed into the facility at the end of the month, R1’s insurance provided money to cover the living expenses for the remaining week of the month. S1 reported that the insurance provided was providing money on a base-by-base scenario. As R1 was hospitalized, the insurance provider did not renew the benefits being rendered to R1 causing R1’s family to have to pay out of pocket.

(Continue to LIC9099AC)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20210616115655
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: 04/15/2026
NARRATIVE
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(Continuation from LIC9099A)

It was alleged that the family wished to terminate their agreement with the facility as the out-of-pocket price was higher than what they could afford at the time. S1 declined the allegation of facility staff unlawfully evicting R1. LPA attempted to speak with R1 and their responsible person, but attempts were unsuccessful. LPA attempted to speak with the insurance provider but were informed that there were no records of who the prior case manager was.

Therefore, the allegation of illegal eviction is deemed 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 allegations are unsubstantiated at this time.

An exit interview was conducted and a copy of this report was provided to the Executive Director.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20210616115655
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: 04/15/2026
NARRATIVE
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(Continuation from LIC9099C)

Staff were informed that R1 sustained multiple injuries from a fall on the curb and were transported to the hospital. Interviews with S3 report that an unknown staff from the previous shift had left a note behind warning the next shift that R1 was at risk of elopement. Records review reported that R1 was admitted into the facility on 5/26/2021. A physicians report dated 5/21/2021, reports that R1 was unable to leave the facility unassisted and is known to be a fall risk. As a result of R1’s elopement, R1 sustained multiple injuries from a fall that occurred outside of the facility.

Therefore, the allegation of resident sustained fractures while in care are deemed substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations Title 22 is being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of the LIC9099, LIC9099C, LIC 9099D, and appeal rights were reviewed and provided to the Executive Director.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20210616115655
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2026
Section Cited
HSC
1569.2(c)
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(c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. This requirement was not met
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Executive Director agreed to conduct an in-service training with staff in regard to how frequent health and safety checks shoulf be done. Proof of training will be submitted to LPA via email by close of business on 5/1/2026.
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with evidence by: (1) one out of (1) one resident eloped from the facility without staff knowledge resulting to Resident #1 (R1) sustaining multiple injuries.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5