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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200661
Report Date: 02/09/2023
Date Signed: 02/09/2023 11:55:13 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/09/2021 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20210809140242
FACILITY NAME:ROSE GARDEN VISTAFACILITY NUMBER:
019200661
ADMINISTRATOR:BAUTISTA, HAIDIEFACILITY TYPE:
735
ADDRESS:1615 HIGH STREETTELEPHONE:
(510) 533-4929
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:15CENSUS: 11DATE:
02/09/2023
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Haidie Bautista, Administrator TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff does not treat resident with dignity or respect & Staff yell at residents in care
Staff isolates residents
Staff not meeting resident's mental health needs
Staff retaliates against resident for complaining
Resident(s) in care are being forced to eat
Staff did not provide aide to a resident who was choking
Staff member refused resident toilet paper upon request.
INVESTIGATION FINDINGS:
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On 02/09/2023 at 9:25AM, Licensing Program Analyst (LPA) L. Ibo conducted an unannounced subsequent complaint visit to deliver the findings of above allegations. LPA explained the reason for the visit with administrator Haidie Bautista. LPA toured the facility and interview residents in care.

Staff does not treat resident with dignity or respect & Staff yell at residents in care

During the course of investigation, residents denied witnessing a staff yelling at the residents or staff being disrespectful to residents in care. Four residents were interviewed during the visit and all four residents denied that staff yelled at them. Based on staff interview, staff denied yelling or being disrespectful to residents in care.

…Continue to LIC9099C…
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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 15-AS-20210809140242
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ROSE GARDEN VISTA
FACILITY NUMBER: 019200661
VISIT DATE: 02/09/2023
NARRATIVE
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Staff isolates residents

Based on interview with staff and residents. Staff denied isolating residents in their room, staff stated that residents can leave their rooms unassisted, all residents living at the facility are ambulatory. LPA conducted interview with residents in care, four residents denied being isolated in their room, according to residents, they can leave their room whenever they want.

Staff not meeting resident's mental health needs

Based on staff and residents’ interview. Residents have their own healthcare team that assist them on their medical and mental health needs. Staff interview revealed that if a resident is showing any change of behavior or condition, the staff immediately inform the Administrator, then the administrator communicates with the residents’ healthcare team to address the issue, this applies to residents physical and mental health needs.

Staff retaliates against resident for complaining

Based on residents’ interview, they denied any form of retaliation from staff. Residents stated that if there are any issue that needs to be address, they approach the staff on duty and that staff on duty will contact Administrator. The Administrator will communicate with the resident and try to solve any conflicts or issues at the facility. Residents stated that they feel safe and comfortable speaking with staff.

Resident(s) in care are being forced to eat

Based on interview with staff and residents. Staff denied forcing anyone to eat. Staff stated that they do encourage the residents to eat their food that was provided but if the residents do not like it, then the resident can request for other available food for that day. LPA conducted interview with residents, and they denied staff forcing them to eat food.

Staff did not provide aide to a resident who was choking

LPA conducted interview with R4, based on interview with R4, she denied chocking incident at the facility. R4 denied witnessing anyone chocking while they are eating their meals. R4 stated that if there is any resident with unusual behavior the staff are always there to assist.

Staff member refused resident toilet paper upon request.

LPA toured the facility during the visit, LPA observed toilet paper available for residents. LPA conducted interview with staff, based on the interview if a resident needs any toiletries including toilet papers, they can always ask for it and staff will provide it to them. Based on residents’ interview, every morning the staff is checking the bathrooms to make sure there are available toilet papers and if it happens that there is no toilet paper in the bathroom the residents are free to request for one from the staff.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are unsubstantiated.

No deficiencies cited. Exit Interview conducted and a copy of this report provided

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2