306005622-2-9-2023-22-AS-AORZ-CP3PPX-20230215103015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005622
Report Date: 01/31/2023
Date Signed: 02/09/2023 10:21:39 AM

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
01/20/2023 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230120085655

FACILITY NAME:	ROSELLE CARE LLC		FACILITY NUMBER:	306005622
ADMINISTRATOR:	ROMEL BISDA		FACILITY TYPE:	740
ADDRESS:	226 HANNAH WAY		TELEPHONE:	(626) 617-8483
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	6	CENSUS:	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alife Manahan- Caregiver		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Resident not accorded dignity in relationships with facility staff.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unnanounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Alife Manahan and explained the reason for the visit. Administrator Romel Bidsa arrived at 9:45 am.

The department received a complaint on 01/23/2023 and the initial 10 day visit was conducted on 01/27/2023. During the course of the investigation the Department interviewed staff, residents and witnesses. In addition the Department obtained copies of pertinent documents such as physician reports and emergency contact information. Regarding the allegation resident not accorded dignity in relationships with facility staff, the investigation revealed the following:

Based on interviews with 3 out of 6 residents they have not experienced any staff that is mean, rude or discourteous. 3 of the residents were unable to be interviewed due to not being oriented to time and space or were asleep. CONT on 9099-C dated

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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-20230120085655

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: ROSELLE CARE LLC	FACILITY NUMBER: 306005622
	VISIT DATE: 01/31/2023

NARRATIVE

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Based on interviews with 4 out of 4 staff they all deny allegations of ever being mean, rude or discourteous to residents. Interviews with 4 out of 4 witnesses reported they have not witnessed or heard of any staff that was mean, rude or discourteous to residents.

Based on the preponderance of evidences through interviews the allegation that resident not accorded dignity in relationships with facility staff is UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.

No deficiencies cited.

An exit interview was conducted and a copy of this report and confidential names list was provided.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
01/20/2023 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230120085655

FACILITY NAME:	ROSELLE CARE LLC		FACILITY NUMBER:	306005622
ADMINISTRATOR:	ROMEL BISDA		FACILITY TYPE:	740
ADDRESS:	226 HANNAH WAY		TELEPHONE:	(626) 617-8483
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	6	CENSUS:	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alife Manahan- Caregiver		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Facility staff not providing water to resident.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry by Alfie Manahan and explained the reason for the visit. Administrator Romel Bisda arrived at 9:45am.

The department received a complaint on 01/23/2023 and the initial 10 day visit was conducted on 01/27/2023. During the course of the investigation the Department interviewed staff, residents and witnesses. In addition the Department obtained copies of pertinent documents such as physician reports and emergency contact information. Regarding the allegation facility staff is not provided water to residents, the investigation revealed the following:

It was alleged that facility staff was denying a resident water. Based on interviews with facility staff they have had to monitor Resident 1 (R1) intake of water due to medical reasons. R1's family and physician have agreed to limit the intake of water. Interviews with 3 out of 6 residents stated they are not denied water.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20230120085655

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: ROSELLE CARE LLC	FACILITY NUMBER: 306005622
	VISIT DATE: 01/31/2023

NARRATIVE

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Based on interviews, 3 of the residents were unable to be interviewed due to not being oriented to time and space or were asleep. Interviews with 4 out of 4 staff indicate they have had to limit water intake for R1. Based on interviews staff reported they do not deny the R1 water, but serve a little less in each glass. In addition the staff provides a gallon of water available for R1's request. Based on interviews, 4 out of 4 witnesses stated they have not heard of the facility denying residents water.

Therefore based on evidence through interviews and observations, the allegation that facility staff are not providing water to residents in UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint.

No deficiencies cited.
An exit interview was conducted and a copy of this report and confidential names list was provided

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4