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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426422
Report Date: 12/15/2023
Date Signed: 12/15/2023 04:42:20 PM


Document Has Been Signed on 12/15/2023 04:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:ROSE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
366426422
ADMINISTRATOR:DANICA TURNERFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:63CENSUS: DATE:
12/15/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
04:40 PM
MET WITH:Danica Turner AdministratorTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Bernadette Allen met with Danica Turner Administrator at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office on12/15/2023 at 4:40 PM to initiate a Case Management Office Visit.

LPA Allen requested that Danica Turner come into the office to sign an amended complaint investigation control number 56-AS-20230912084226 that was conducted on 10/30/2023. The report was missing some investigation information based on interviews, observations, and medical records.

An exit interview was conducted where this report was discussed, and a copy was provided to Danica Turner Administrator at the conclusion of the visit.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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