366426422-4-29-2026-56-AS-NBRN-DTMUJ6-20260430153700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 04/29/2026
Date Signed: 04/29/2026 03:23:57 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
02/26/2026 and conducted by Evaluator Edith Conchas

COMPLAINT CONTROL NUMBER: 56-AS-20260226163653

FACILITY NAME:	ROSE GARDEN RESIDENTIAL CARE		FACILITY NUMBER:	366426422
ADMINISTRATOR:	SCHAMONE BARD		FACILITY TYPE:	740
ADDRESS:	1350 WABASH AVE.		TELEPHONE:	(909) 794-1040
CITY:	MENTONE	STATE: CA	ZIP CODE:	92359
CAPACITY:	63	CENSUS: 47	DATE:	04/29/2026
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Administrator, Melissa Buckridge		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff mismanaged resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) E.Conchas made an unannounced visit to the facility to conduct complaint investigation for the allegation stated above. LPA met with Administrator, Melissa Buckridge and explained the reason for the visit.

During today's visit, LPA conducted interviews with staff, residents, a witness, as well as reviewed pertinent documents.

Based on the allegation that staff mismanaged medication, three of four residents reported they do receive their medications from staff. Two of four residents stated that staff have not missed their medications or given incorrect medications. One witness reported having no issues or concerns regarding their family member receiving medications from staff.

Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20260226163653

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: 04/29/2026

NARRATIVE

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Interview with S2 stated R1 would pocket or spit out food, but at times R1 would still take their medication. S3 interview stated R1 began refusing or pocketing food approximately one week prior to transitioning towards end of life. S4 stated that although R1 was sometimes not eating, the medication was small enough to be crushed and given in a spoonful, though at times R1 would drool it out.

LPA reviewed R1’s medication records and physician orders. Facility documentation reflected a mechanical soft diet with thin liquids and an order for crushed medications, while hospice records reflected a physician order for a puree diet. Due to limited staff notes, LPA was unable to verify all dates of medication administration.

Based on record review and interviews, the allegations that staff mismanaged medications is Unsubstantiated. Unsubstantiated meaning that 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.
An exit interview was conducted were this report was discussed and a copy provided to Administrator, Melissa Buckridge

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026

LIC9099 (FAS) - (06/04)

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