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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802133
Report Date: 11/14/2024
Date Signed: 11/14/2024 02:07:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2024 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20241107134508
FACILITY NAME:ROSE GARDEN MANOR IVFACILITY NUMBER:
565802133
ADMINISTRATOR:SORATORIO, AMALIAFACILITY TYPE:
740
ADDRESS:745 BERKSHIRE PLACETELEPHONE:
(805) 246-5148
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 6DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Amalia Soratorio, Licensee TIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff did not allow resident to have visitors while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 11:30 a.m., the LPA called the Licensee, Amalia Soratorio and explained the reason for the visit. At 11:45 a.m., the Licensee arrived at the facility and allowed the LPA entrance to the facility.

Between 11:51 a.m. and 1:40 p.m., the LPA conducted interviews with the Licensee and four (4) residents. At 12:50 p.m., the LPA along with the Licensee conducted a physical plant tour. At 12:58 p.m., the LPA obtained copies of pertinent documents.

Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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 29-AS-20241107134508
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROSE GARDEN MANOR IV
FACILITY NUMBER: 565802133
VISIT DATE: 11/14/2024
NARRATIVE
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Regarding the allegation: Staff did not allow resident to have visitors while in care. On 11/07/2024, the Department received a complaint alleging facility staff restricting Resident #1 (R1) visitation from Individual #1 (I1). It was alleged that I1 attempted to visit R1 last year in January 2023 and that staff did not allow I1 to see R1. Per interview with Licensee, it was revealed that facility staff did not restrict I1 from visiting R1 instead I1 came to the facility in the morning while R1 was at day program. The Licensee explained that I1 has not returned to the facility since then. The Licensee stated that residents are always allowed visitors and that majority of the residents do receive visitors or residents leave the facility with family. The LPA reminded the Licensee that facility staff cannot restrict visitation unless there are legal documents such as a restraining order in place. The LPA reminded the Licensee to keep a copy of such legal documents in resident’s files. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. 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 deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
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