306005622-3-2-2023-22-AS-SSAS-CQTUWT-20230412155712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005622
Report Date: 03/02/2023
Date Signed: 03/02/2023 10:37:03 AM

Substantiated

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
03/01/2023 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230301092615

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: 6	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Alfie Manahan, Romel Bisda		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Licensee improperly transferred ownership and/or control of the facility

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Staff #1 (S1) Alfie Manahan, discussed the purpose of the inspection, and explained the allegation. Administrator (AD) Romel Bisda arrived during the inspection.

The investigation into the allegation that Licensee improperly transferred ownership and/or control of the facility revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, staff, and witnesses, and requested and reviewed copies of the resident roster, staff roster, and resident files.

It was reported that on 02/28/23, Witness #1 (W1) Joseph Laxamana and his partner Witness #2 (W2) Mary Joy Garcia arrived at the facility, were not trained or knowledgeable about the residents in care, claimed to be the new owners,

Substantiated

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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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-20230301092615

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: 03/02/2023

NARRATIVE

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attempted to terminate the current staff who were knowledgeable about the residents in care, the police were called, Department staff intervened via telephone, and AD agreed to keep the current staff in place and remove W1 and W2 from the facility.

During the inspection, LPA and S1 toured the facility. LPA observed there were 2 staff present, wearing PPE. LPA observed 6 resident present. LPA conducted health and safety checks on the 6 residents present and confirmed they were doing well and observed no health and safety issues. LPA observed the facility to be clean and organized, and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed the electricity and water were running and the facility had soap and paper towels.

LPA interviewed AD, W1, and S1 who corroborated and admitted the incident on 02/28/23 occurred as reported. AD and W1 apologized and stated the events should not have occurred as they did. AD and W1 stated that AD is in the process of selling the business to W1, that W1 will work at the facility as an employee house manager until the sale is finalized, and that W1 will submit an application for change of ownership, but that AD is still the owner of and in control of the facility. AD admitted that AD did not follow the proper procedures for a change of ownership, that the Department was not notified of the pending sale, and that residents and their responsible parties were not notified either. AD and W1 stated the deal they had to transfer ownership and/or control of the facility has been rescinded and moving forward they will follow the proper procedures for a change of ownership. AD stated that AD will ensure the facility is adequately staffed with trained, background cleared and associated staff, and that the facility will maintain up to date staff rosters and staff files. AD admitted that if the Department had not intervened, additional violations would have occurred, because W1 and W2, who were not trained or knowledgeable about the residents in care, would have dismissed the current staff, who were trained and knowledgeable, from the facility, leaving the residents without qualified staff to care for them.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights 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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230301092615

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/03/2023 Section Cited HSC 1569.191(a)(1)	1 2 3 4 5 6 7	§1569.191 Sale of licensed facility… (a) … (1) The licensee shall provide written notice to the department and to each resident or his or her legal representative of the licensee's intent to sell the facility at least 30 days prior... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated the deal to transfer ownership and/or control of the facility has been rescinded and moving forward they will follow the proper procedures for a change of ownership. POC CLEARED
	8 9 10 11 12 13 14	Based on interviews, the licensee admitted that he is in the process of selling the facility, but did not follow proper procedures, notify the Department, or notify residents or their responsible parties, which poses an immediate safety and personal rights and safety risk to residents in care.	8 9 10 11 12 13 14
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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