306005299-2-26-2024-22-AS-AJLO-D3HUST-20240319155052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005299
Report Date: 02/26/2024
Date Signed: 02/26/2024 10:35:44 AM

Unsubstantiated

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
11/02/2022 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221102141015

FACILITY NAME:	ROSEWOOD CARE HOME		FACILITY NUMBER:	306005299
ADMINISTRATOR:	MALLARI, ANNA		FACILITY TYPE:	740
ADDRESS:	10821 VICKERS DRIVE		TELEPHONE:	(657) 667-0698
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92840
CAPACITY:	6	CENSUS: 4	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Narciso De Guzman		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Personal Rights

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation(s). LPA met with Staff #1 (S1) Narciso De Guzman and explained the reason for today’s inspection. Administrator (AD) Anna Mallari appeared via telephone.

The investigation into the allegation of Personal Rights revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, clients, staff, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, client files, Client #1’s (C1) Providence Saint Joseph Orange Cancer Center medical records dated 10/31/22, C1’s UCI Medical Center medical records dated 11/02/22, and the Garden Grove Police Department Officer Report for Incident 22063329.

Regarding the allegation of Personal Rights: It was alleged that C1 had experienced a suspected personal rights violation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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-20221102141015

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: ROSEWOOD CARE HOME	FACILITY NUMBER: 306005299
	VISIT DATE: 02/26/2024

NARRATIVE

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LPA inspected the facility and observed no health and safety issues or personal rights violations. LPA interviewed two staff and did not obtain information corroborating the allegation. One staff reported that on 11/01/22, police officers arrived at the facility, explained that a suspected personal rights violation had been reported, spoke with C1, and removed C1 from the facility. Per the staff interviewed, C1 returned to the facility the next day on 11/02/22. LPA conducted health and safety checks on three clients, including C1, and observed no health and safety issues. LPA interviewed the three clients, one of whom was non-verbal, and did not obtain information corroborating the allegation. LPA interviewed AD and did not obtain information corroborating the allegation. LPA interviewed one witness who reported picking C1 up from UCI Medical Center on 11/02/22 and returning C1 to the facility that same day after receiving no information from C1, UCI Medical Center, or the police corroborating that a personal rights violation had occurred or that C1 would not be safe at the facility. LPA subpoenaed and reviewed C1’s Providence Saint Joseph Orange Cancer Center medical records dated 10/31/22 which detail why a personal rights violation was suspected, but do not provide information corroborating the allegation. LPA subpoenaed and reviewed C1’s UCI Medical Center medical records dated 11/02/22 which indicate C1 underwent examination at Anaheim Regional Medical Center to determine whether a personal rights violation had occurred prior to C1 being admitted to UCI Medical Center, but do not provide the outcome of that examination or other information corroborating the allegation. LPA subpoenaed C1’s medical records from Anaheim Regional Medical Center, but Anaheim Regional Medical Center provided no medical records because C1 was never a patient there. Per the Garden Grove Police Department Officer Report for Incident 22063329, the examination at Anaheim Regional Medical Center was begun but not completed and no information was obtained corroborating that a personal rights violation has occurred. Interviews with the witness and AD revealed that C1 has been back at the facility since 11/02/22 with no issues reported since then.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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