366426422-3-1-2024-56-AS-EMAN-D5GMUH-20240521095510

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 03/01/2024
Date Signed: 03/01/2024 01:19:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/26/2023 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231226104943

FACILITY NAME:	ROSE GARDEN RESIDENTIAL CARE		FACILITY NUMBER:	366426422
ADMINISTRATOR:	DANICA TURNER		FACILITY TYPE:	740
ADDRESS:	1350 WABASH AVE.		TELEPHONE:	(909) 794-1040
CITY:	MENTONE	STATE: CA	ZIP CODE:	92359
CAPACITY:	63	CENSUS: 54	DATE:	03/01/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	David Monroy VIP Operations		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff neglected resident while in care
Staff did not meet resident's medical needs
Staff did not administer resident's medication as prescribed
Staff did not meet resident's hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Business Manager Jackie McDonald and Wellness Director Gabriel Salazar and explained the purpose of the visit. The investigation consisted of staff interviews, document reviews, and facility tour.

For the allegation, Staff neglected resident while in care.

LPA Rico conducted five (5) staff interviews. 5 out of the 5 staff informed they have not neglected the residents while in care. 3 out of the 5 staff members stated they have not witnessed a staff member neglect a resident. During interviews with residents, LPA Rico did not find evidence to corroborate the allegation.

For the allegation, Staff did not meet resident's medical needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

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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Control Number 56-AS-20231226104943

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROSE GARDEN RESIDENTIAL CARE	FACILITY NUMBER: 366426422
	VISIT DATE: 03/01/2024

NARRATIVE

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LPA Rico conducted five (5) staff interviews. 5 out of the 5 staff stated they meet resident’s medical needs. During interviews with residents, LPA Rico did not find evidence to corroborate the allegation.

For the allegation, Staff did not administer resident's medication as prescribed.

LPA Rico conducted five (5) staff interviews. 5 out of the 5 staff informed LPA residents received their medication as prescribed unless a resident refuses their medication. S1 informed LPA that R1 medication was cancelled through R1 POA. LPA received documentation of cancellation .During interviews with residents, LPA Rico did not find evidence to corroborate the allegation.

For the allegation, Staff did not meet resident's hygiene needs.

LPA Rico conducted five (5) staff interviews. 5 out of the 5 staff stated they meet resident’s hygiene needs. 4 out of the 5 staff stated they have not witnessed a staff member refused hygiene needs to a resident. During interviews with residents, LPA Rico did not find evidence to corroborate the allegation.

Based on the evidence found during the investigation, the four (4) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to David Monroy VIP Operations along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

LIC9099 (FAS) - (06/04)

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