306003448-1-8-2024-22-AS-AORZ-CZDRGU-20240111120120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003448
Report Date: 01/08/2024
Date Signed: 01/08/2024 01:16:41 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/03/2024 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20240103132234

FACILITY NAME:	FULLERTON ROSEWOOD ASSISTED LIVING		FACILITY NUMBER:	306003448
ADMINISTRATOR:	JANE KIM		FACILITY TYPE:	740
ADDRESS:	411 E. COMMONWEALTH AVENUE		TELEPHONE:	(714) 441-0644
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92832
CAPACITY:	99	CENSUS: 60	DATE:	01/08/2024
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Jane Kim		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Medication not being administered properly
Facility not allowing visitors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility, interviewed staff and residents as well as reviewed and obtained pertinent documentation such as medication training records. Regarding the allegation that medication not being administered properly and facility not allowing visitors, the investigation revealed the following: Facility protocol is to have caregivers/ med techs administering medications in the dining room before meals. Caregivers assist in the dining room with serving meals to residents. Residents may interact with the same caregiver who passed medications during their meal. LPA reviewed medication training records and all staff administering medications have proof of current medication training. Upon entry to the facility, LPA observed front door is locked with a bell and phone number to call for entry. LPA rang bell and was immediately greeted into the facility. Administrator indicates locking the front door for the last several weeks due to covid cases. CONTINUED ON LIC 9099C DATED 1/8/2024

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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 22-AS-20240103132234

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: FULLERTON ROSEWOOD ASSISTED LIVING	FACILITY NUMBER: 306003448
	VISIT DATE: 01/08/2024

NARRATIVE

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Administrator states door is locked so staff can advise all guests of covid status and to deter outside traffic from entering during active covid cases. The back door is open and unlocked which backs up to the parking lot. Administrator indicates most visitors utilize the back entrance. LPA observed visitors in the facility as well as staff answering the front door promptly. Eight out of eight residents and four out of four staff deny visitors are denied entrance into the facility. All residents interviewed indicated their family members visit frequently and have had no issues with visitation. Facility does not house residents with Dementia. Based on record review and interviews conducted, the allegations are deemed UNFOUNDED meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to Administrator.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

LIC9099 (FAS) - (06/04)

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