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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004441
Report Date: 01/08/2024
Date Signed: 01/08/2024 03:56:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
01/02/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240102095248
FACILITY NAME:ROSIE'S RESIDENTIAL CAREFACILITY NUMBER:
306004441
ADMINISTRATOR:JAIME RUALOFACILITY TYPE:
735
ADDRESS:1921 W.HALL AVENUETELEPHONE:
(714) 831-1335
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:6CENSUS: 3DATE:
01/08/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Sandra Vazquez-Caregiver, Maricella Marin-AdministratorTIME COMPLETED:
04:14 PM
ALLEGATION(S):
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Staff do not provide adequate food service
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Caregiver Sandra Vazquez. LPA explained the reason for the visit. Administrator (AD) Maricella Marin arrived shortly after.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Three of five individuals interviewed denied the allegation. During the initial visit on 01/08/24 LPA tour the kitchen and observed the facility to have a two-day perishable and seven-day non-perishable supply of food for three clients in care. During interviews conducted with the clients, C1 reported that staff provide great food service and stated that the food options change everyday. During interviews conducted with staff, Staff 1 (S1) reported that staff provide adequate food service and that there are always enough groceries to come up with a meal.
CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
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)
Page: 1 of 3
Control Number 22-AS-20240102095248
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROSIE'S RESIDENTIAL CARE
FACILITY NUMBER: 306004441
VISIT DATE: 01/08/2024
NARRATIVE
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Per S2 he makes a variety of dinner meals because he likes cooking and reported that he likes to prepare a balance meal for the clients.

Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with AD Marin, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
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)
Page: 2 of 3