198603163-5-19-2026-28-AS-LHIS-DUHUYF-20260528155953

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603163
Report Date: 05/19/2026
Date Signed: 05/19/2026 02:28:01 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2026 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260519110404

FACILITY NAME:	CALIFORNIA MISSION INN - ROSE MANOR		FACILITY NUMBER:	198603163
ADMINISTRATOR:	JARED GREEN		FACILITY TYPE:	740
ADDRESS:	4825 EARLE AVE		TELEPHONE:	(626) 287-0438
CITY:	ROSEMEAD	STATE: CA	ZIP CODE:	91770
CAPACITY:	85	CENSUS: 63	DATE:	05/19/2026
		UNANNOUNCED	TIME BEGAN:	12:22 PM
MET WITH:	Maria Roleda, Wellness Director		TIME COMPLETED:	02:33 PM

ALLEGATION(S):

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Staff are making inappropriate comments in the presence of resident(s) in care.
Staff interrupted the sleep of a resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made initial visit to investigate the above allegations. LPA met with Maria Roleda – Wellness Director and discussed the purpose of the visit.

The investigation consisted of LPA reviewing and obtaining copies of resident and staff rosters, R1 physicians report, interviewing four (4) staff and six (6) residents adjacent to R1 room, and taking a tour of common areas and resident rooms.

The investigation revealed: Regarding Allegation: Staff are making inappropriate comments in the presence of resident(s) in care. It is alleged that staff and/or other residents are making loud, intrusive and inappropriate comments and harassing resident on May 13, 2026, at around 2:22 am.
LPA interviewed four (4) staff and all four (4) staff denied the allegations. LPA interviewed six (6) residents and all six (6) could not corroborate the allegations. (continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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 28-AS-20260519110404

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CALIFORNIA MISSION INN - ROSE MANOR	FACILITY NUMBER: 198603163
	VISIT DATE: 05/19/2026

NARRATIVE

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(continued on 9099C)

Residents in adjacent rooms stated they do not hear sounds in the middle of the night. R1 stated that the sounds are coming from the adjacent room to the north side of resident's room. However, that room has been vacant since the beginning of the day on May 12, 2026 by 11:00am . Asked if R1 heard any sounds yesterday or this week coming from the unoccupied room, resident stated resident thinks resident heard sounds. R1 stated R1 will try to record the sounds next time. R1 could not identify the person(s) who are making the sounds or noise. There is no evidence to support this allegation.

Allegation: Staff interrupted the sleep of a resident in care. It is alleged that resident was intentionally awaken when resident arrived at facility after being out on lengthy journey. LPA interviewed four (4) staff and all four (4) staff denied the allegations. LPA interviewed six (6) clients and all six (6) could not corroborate the allegation. R1 could not identify the person(s) who woke R1 up. Other residents interviewed stated they are not awakened in the middle of the night or anytime they are sleeping. There is no evidence to substantiate this allegation.

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

No deficiencies were cited during this investigation. Exit interview was conducted. A copy of this report was provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

LIC9099 (FAS) - (06/04)

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