366425370-2-10-2023-56-AS-NBRN-CQBPSX-20230327113505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425370
Report Date: 02/10/2023
Date Signed: 02/10/2023 03:49:04 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
08/18/2022 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220818142838

FACILITY NAME:	ROSE VILLA		FACILITY NUMBER:	366425370
ADMINISTRATOR:	MANZOOR R. MASSEY		FACILITY TYPE:	740
ADDRESS:	11906 KINGSTON STREET		TELEPHONE:	(909) 825-7673
CITY:	GRAND TERRACE	STATE: CA	ZIP CODE:	92313
CAPACITY:	6	CENSUS: 5	DATE:	02/10/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Regina Albudriz, lead		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff handled resident roughly
Staff did not treat resident with respect
Staff mismanaged resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Anna Bueno and Michelle Echeverria conducted an unannounced visit to the facility to deliver findings on the above allegations. The investigation consisted of file reviews, interviews with staff and witnesses. Residents 1 and 2 were not able to be interviewed due to their absence. LPAs identified themselves to lead staff Regina Albidriz, who was notified of the reason for today’s visit. Designee Janet Oliver arrived during today's visit and LPA Michelle Echeverria left the facility before the conclusion of today's visit.

Allegation 1: Staff handled resident roughly. LPA Bueno interviewed residents who denied that staff have been rough with them . Interviews with visiting third parties confirmed that residents have not mentioned nor complained of staff maltreatment. This allegation is therefore unsubstantiated.

Allegation 2: Staff did not treat resident with respect. Interviews with residents did not reveal that staff are disrespectful to residents. Staff interviews stated that they like all their residents and do not disrespect them. Furthermore, staff interviews reveal that some staff speak aggressively to other staff. This allegation is

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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 56-AS-20220818142838

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: ROSE VILLA	FACILITY NUMBER: 366425370
	VISIT DATE: 02/10/2023

NARRATIVE

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unsubstantiated.

Allegation 3: Staff mismanaged resident's medication. Records reviewed show that residents were receiving their medication as prescribed. LPA Bueno attempted to speak with Resident 2 witness but was not able to conduct any interview. Interview with Resident 1 witness confirmed that medications were being received according to medical instruction. This allegation is unsubstantiated.

Based on the available information, we have found the complaint allegations to be UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Janet Oliver at the conclusion of the visit.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

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