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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426422
Report Date: 08/08/2025
Date Signed: 08/08/2025 12:26:33 PM

Substantiated


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
03/08/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240308092901
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: 57DATE:
08/08/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michelle Reyes- Business Office ManagerTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff do not properly maintain the facility
Staff mishandled a resident's personal belongings
Staff do not have adequate record keeping for a resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Business Office Manager Michelle Reyes and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Staff do not properly maintain the facility. Regarding the first allegation pertaining to “Staff do not properly maintain the facility” on 3/13/2024 LPA conducted an inspection inside cottage B of the facility LPA observed first room to be in despair LPA was informed by facility maintenance manager that facility is in the process of conducting repairs. In addition, during the inspection in cottage B LPA observed bathroom to be unsanitary, LPA observed a soiled diaper and paper towels to be laying on the bathroom floor.

Second allegation: Staff mishandled a resident's personal belongings. Regarding the allegation stated above LPA requested documentation pertaining to Resident #1 during record review LPA observed that R#1 did not have an inventory sheet listing R#1 personal property.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 56-AS-20240308092901
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: 08/08/2025
NARRATIVE
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In addition, based on R#1 admission agreement LPA observed facility to have a theft and loss program, which indicated that facility maintain a theft and loss policy. During further review LPA observed that R#1 did not have a theft and loss policy on file.

Third allegation: Staff do not have adequate record keeping for a resident. Regarding the allegation stated above LPA collected documentation pertaining Resident #1 during record review LPA discovered that R#1 inventory form was missing in addition, LPA also discovered that R#1 theft and policy form was also missing and not to be found. Based on review of records and evidence gathered the above allegations are Substantiated.

Substantiated: A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, Maintenance and Operation 87303(a), Theft and Loss 87218(a)(1)(2), Resident Records 87506(a)(1), from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided, along with a copy of the appeal rights to Facility Business Office Manager Michelle Reyes.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 56-AS-20240308092901
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2025
Section Cited
CCR
87303(a)
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Maintenance and Operation... (a) the facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidence by:
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Licensee has agreed to read over the Maintenance and Operation regulation and provide training to all staff. Administrator will provide a copy of the training that is signed and dated by staff to LPA on POC date 8/15/2025.
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Based on observation, facility did not follow maintenance and operation regulation to keep facility clean, sanitary and in good repair for 1 out of 4 units, which poses a potential health, safety, or Personal Rights risk to persons in care.
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Type B
08/15/2025
Section Cited
CCR
87218(a)(1)(2)
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Theft and Loss 87218.... (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153.... (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.... (2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153.

This requirement is not met as evidence by:
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Licensee has agreed to read over the Theft and Loss regulation and provide training to all support staff on how to properly record resident’s personal belongings. Licensee will provide a copy of training that is signed and dated by staff to LPA on POC date 8/15/2025.
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Based on record review, facility did not follow theft & loss regulation for Resident#1 leading to R#1 loss and mismanagement of R#1 personal belongings, which poses a potential health, safety, or Personal Rights risk to persons in care.
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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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
03/08/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240308092901

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: 57DATE:
08/08/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michelle Reyes- Business Office ManagerTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not provide adequate care and supervision
Staff do not have planned activities for the residents
Staff did not provide comfortable accommodations for a resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
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9
10
11
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13
Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Business Office Manager Michelle Reyes and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Staff do not provide adequate care and supervision. Regarding the allegation LPA conducted interviews with Residents #1-3 all residents informed LPA that they receive adequate care and supervision. In addition, R#1-3 informed LPA that they have no issues to report pertaining to care and supervision. LPA conducted an interview with Staff #1 who informed LPA that facility is currently staffed S#1 provided LPA with current staff roster LPA observed that facility had an equivalent number of staff to meet supervising and care needs for all residents in care.

Second allegation: Staff do not have planned activities for the residents. Regarding the allegation listed above LPA conducted a walkthrough of the facility LPA observed facility to have an activity room located in
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 56-AS-20240308092901
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: 08/08/2025
NARRATIVE
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the (L unit). LPA collected activity calendars. On 8/8/2025 LPA conducted a follow-up inspection and observed that activity room is still located in (L unit), LPA observed residents playing bingo. In addition, LPA collected an activity calendar for the month of August.

Third allegation: Staff did not provide comfortable accommodations for a resident. Regarding the allegation stated above LPA conducted interviews with Residents 1-3 regarding the allegation “staff did not provide comfortable accommodations for a resident” all residents informed LPA that they have no issues to report regarding the allegation and feel that their accommodations are being met by staff. LPA conducted a walkthrough of the facility and observed units to have a working AC, LPA observed all rooms to be cool/and fresh. LPA conducted interviews with Staff 2-4 and all staff informed LPA that all residents receive comfortable accommodations. In addition, Staff #3 informed LPA that facility has water available in dining area. Furthermore, S#3 informed LPA that during round checks caregivers provide water to residents daily. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.

Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Business Office Manager Michelle Reyes at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 56-AS-20240308092901
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2025
Section Cited
CCR
87506(a)(1)
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87506 Resident Records....(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.....(1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.

This requirement is not met as evidenced by:


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Licensee has agreed to read over the regulation and provide training on regulation “87506 Resident Records” Licensee will email LPA a copy of the training signed and acknowledge by all staff by POC date 8/15/25.
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Based on interviews and record review, the licensee did not follow title 22 regulation pertaining to “resident records” by not storing active and inactive records and not safeguarding R#1 records, which poses a potential health, safety, or Personal Rights risk to persons in care.
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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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6