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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 150400536
Report Date: 10/18/2021
Date Signed: 10/19/2021 12:08:59 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2021 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210126135433
FACILITY NAME:ROSEWOOD RETIREMENT COMMUNITYFACILITY NUMBER:
150400536
ADMINISTRATOR:BALABAN, ROCHELLEFACILITY TYPE:
741
ADDRESS:1301 NEW STINE ROADTELEPHONE:
(661) 834-0620
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:220CENSUS: 153DATE:
10/18/2021
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Rochelle Balaban, AdministratorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility staff financially abused resident.
Facility increased resident's rate without proper notice.
INVESTIGATION FINDINGS:
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On 10/18/21 at 8:45 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. LPA was granted entry by front receptionist. LPA met with Administrator (ADM) Rochelle Balaban.

During the course of the investigation, LPA conducted interviews and reviewed records. Based on LPA’s observations, interviews, and records reviewed, the preponderance of evidence standard has been met. Facility self reported S1 was found to have financially abused R1. S1 admitted to receiving checks from R1. Facility increased R1’s monthly fee due for January and February 2021 without the proper advance written notice of 60 days. The above allegations are substantiated.

Deficiencies are being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9909D.

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and emailed to the email address on record with “Read receipt” to confirm receipt of this report.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 650-7931
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
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 24-AS-20210126135433
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ROSEWOOD RETIREMENT COMMUNITY
FACILITY NUMBER: 150400536
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/10/2021
Section Cited
CCR
87468.2(a)(8)
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Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation...

This requirement is not met as evidenced by:
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Administrator will submit a plan by the due date, detailing how facility plans to ensure that resident is made whole for the money staff stole from resident. Plan shall include a date that staff will be re-trained on facility’s theft and loss policy and resident personal rights.
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During the course of the investigation, facility self reported S1 was found to have financially abused R1. S1 admitted to receiving checks from R1. This poses a potential personal rights risk to residents in care.
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Type B
11/01/2021
Section Cited
HSC
1569.655(a)
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Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase;...(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents...the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs,...

This requirement is not met as evidenced by:
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Administrator will provide proof of a plan to properly notify residents once a resident no longer qualifies for the facility's internal benevolence funding program, to CCL by POC due date.
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During the course of the investigation, LPA found that facility increased R1’s monthly fee due for January and February 2021 without the proper advance written notice of 60 days. This poses a potential personal rights risk to residents in care.
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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.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 650-7931
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
LIC9099 (FAS) - (06/04)
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