019200661-2-1-2024-15-AS-YFLS-D35U83-20240307142053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200661
Report Date: 02/01/2024
Date Signed: 02/01/2024 01:13:22 PM

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
01/23/2024 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20240123160856

FACILITY NAME:	ROSE GARDEN VISTA		FACILITY NUMBER:	019200661
ADMINISTRATOR:	HASMIN B KOO		FACILITY TYPE:	735
ADDRESS:	1615 HIGH STREET		TELEPHONE:	(510) 533-4929
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	15	CENSUS: 13	DATE:	02/01/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Haidie Bautista, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not safeguard resident’s mail
Staff tampered with resident’s meals

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 2/01/24 at 12:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPA met with Administrator, Haidie Bautista and informed her the reason for visit.

During the course of investigation, LPA interviewed S1 and reviewed R1's file. R1 is no longer at the facility. She left on 1/31/24 telling the S1 that she "has money" and wants to live on her own. File review revealed that R1 has a diagnosis of "schizophrenia." R1's doctor's summary also states R1 "presented with paranoia."

This agency has investigated the complaint alleging staff did not safeguard resident’s mail
and staff tampered with resident’s meals. We have found that the complaint was unsubstantiated. 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.

Exit interview conducted, a copy of this report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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 1