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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412134
Report Date: 11/14/2024
Date Signed: 11/14/2024 01:45:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2023 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230410081047
FACILITY NAME:ROSALINA'S HOME CAREFACILITY NUMBER:
336412134
ADMINISTRATOR:OLAH, ROSALINAFACILITY TYPE:
740
ADDRESS:6890 JURUPA ROADTELEPHONE:
(951) 360-1334
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:6CENSUS: 3DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Rosalinda and Elizabeth OlahTIME COMPLETED:
01:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to provided resident documentation upon written request
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to concluded a complaint investigation regarding the above allegation. LPA Prieto met with staff Elizabeth Olah and explained the elements of the complaint.

Allegation #1, staff Elizabeth Olah produced documentation showing that records were delivered to the requestor after written request was received. Those records were obtained by LPA during time of investigation.

Based on the information obtained there is not enough evidence that facility failed to provided resident documentation upon written request . Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and staff Olah and a copy was left at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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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