197603417-7-6-2023-31-AS-MVAO-CWWTJH-20231024144622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603417
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:38:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/27/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230627101203

FACILITY NAME:	ROSANNA ADULT RESIDENTIAL HOME		FACILITY NUMBER:	197603417
ADMINISTRATOR:	ROSANNA J. TOMANENG		FACILITY TYPE:	735
ADDRESS:	14605 HIAWATHA STREET		TELEPHONE:	(818) 897-6964
CITY:	MISSION HILLS	STATE: CA	ZIP CODE:	91345
CAPACITY:	6	CENSUS: 6	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Rosanna Tomaneng - Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff speaks inappropriately to resident in care

Staff does not provide adequate food service to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegations. LPA met with the administrator Rosanna Tomaneng and explained the reason for the visit.

LPA conducted physical plant tour at 9:16 AM, requested copies of facility documents relevant to the investigation at 9:49 AM and interviewed staff and residents between 10:00 AM to 12:30 AM. Regarding the allegation that Staff speaks inappropriately to resident in care, it was alleged that the staff of the facility told Resident #1 (R1) that R1 gained 20 lbs. LPA's interview with staff today between 10:00 AM to 12:30 PM revealed that all of the residents are being weighed every month as required and it was R1 who asked the staff how much R1 weigh during the weighing on 05/19/23 and the staff answered R1 how much R1 weigh and gained during the month compared to the prior month. LPA's interview with administrator today at 12:13 PM also revealed that on 06/19/23, upon the recommendation of R1's Primary Care Physician (PCP), R1 was brought to the clinic due to R1's medical condition being overweight (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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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Control Number 31-AS-20230627101203

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROSANNA ADULT RESIDENTIAL HOME	FACILITY NUMBER: 197603417
	VISIT DATE: 07/06/2023

NARRATIVE

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(continued from LIC 9099)

Further, administrator admitted that she told R1 to lose weight per the doctor's advise, not that R1 gained weight.

Regarding the allegation that Staff does not provide adequate food service to resident, it was alleged that R1 was only given a small portion of food when other residents were given bigger piece. LPA's interview with staff today between 10:00 AM to 12:30 AM revealed that all residents were given the same food at any given time with the same portion, unless a resident requested a different meal and/or would like to cook their food by themselves. Further interview also revealed that R1 usually cooked own food at least twice a week during dinner and ordered food delivery whenever R1 wanted to. Moreover, all residents are allowed to have second serving if any one of them asked. LPA's interview with three (3) aware residents also confirmed that they were being served the same food and same amount by the staff at all times. All residents interviewed also stated that they can get second servings whenever they asked.

Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

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