157202405-8-10-2020-24-AS-AXIG-BSUMU8-20200826095441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157202405
Report Date: 08/10/2020
Date Signed: 08/10/2020 04:46:56 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
06/12/2020 and conducted by Evaluator See Moua

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20200612141133

FACILITY NAME:	ROSE GARDEN		FACILITY NUMBER:	157202405
ADMINISTRATOR:	HUSSAIN, BARKET		FACILITY TYPE:	740
ADDRESS:	810 S UNION AVENUE		TELEPHONE:	(661) 633-2263
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93307
CAPACITY:	41	CENSUS: 36	DATE:	08/10/2020
		UNANNOUNCED	TIME BEGAN:	07:59 AM
MET WITH:	Bucky Hussain, Administrator		TIME COMPLETED:	08:00 AM

ALLEGATION(S):

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Facility failed to protect resident from harm.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S. Moua contacted the facility on this date telephonically due to COVID-19 precautionary measures. LPA spoke with Administrator Bucky and reviewed the allegations. Findings were delivered.

Facility staff and resident were interviewed by the Department. Both parities denied that the facility failed to protect the resident from harm. The resident was unable to explain how he obtained a scar above his eyebrow. Facility staff explained the scar may have been a result of the resident’s aggressive behaviors when staff wasn’t present. Based on interviews conducted, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiency was observed. Exit Interview was conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda White	TELEPHONE: (559) 650-7908
LICENSING EVALUATOR NAME: See Moua	TELEPHONE: (559) 580-6596
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2020

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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