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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004441
Report Date: 02/22/2024
Date Signed: 02/22/2024 03:48:55 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
02/12/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240212155916
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:
02/22/2024
UNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Sandra Vazquez-Caregiver, Karry Vallejo-AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee does not ensure facility is adequately staffed to meet residents needs
Facility staff do not provide adequate food service to residents
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 allegations 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) Karry Vallejo arrived shortly after.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegations, the following was revealed: Two of three individuals denied the allegations. During interviews conducted with staff, Staff 1 (S1) reported that the facility has adequate staff to meet the client needs. During the interviews AD stated that the facility has enough staff and reported that there is one caregiver for the morning, evening and night shifts. Per AD the AD Assistant is a backup caregiver and is usually at the facility half of the day. During the investigation LPA reviewed documents including the Personnel Report (LIC500) dated 02/12/24.
CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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 4
Control Number 22-AS-20240212155916
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: 02/22/2024
NARRATIVE
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Per Personnel Report there is one caregiver for the morning, evening and night shift for three clients in care. Per Personnel Report on Saturday and Sunday there are two caregivers for the morning and evening shifts.

Regarding the allegation that facility staff do not provide adequate food service to residents, the investigation revealed the following: During the initial visit on 02/22/24 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 the initial visit LPA observed as caregiver cooked noodles soup, a grilled sandwich and mixed fruit for lunch. Per S1 she provides good food service to the clients in care. During the interviews, AD stated that the clients have plenty of options to eat from and reported that she purchases groceries according to what the clients like.

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

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

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4