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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426422
Report Date: 12/19/2024
Date Signed: 12/19/2024 11:18:56 AM

Document Has Been Signed on 12/19/2024 11:18 AM - 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/
DIRECTOR:		GARCIA, CELIAFACILITY TYPE:
740
ADDRESS:1350 WABASH AVE.TELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY: 63CENSUS: 50DATE:
12/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Marlene Delgado-Wellness DirectorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced case management visit to interview residents, staff, and obtain additional documents for the complaints listed below. LPA met with Business Office Manager Michelle Reyes and informed her of the purpose of the visit. Michelle stated she would have to leave and Wellness Director, Marlene Delgado could sign the report.

LPA Allen conducted interviews with staff, residents, responsible parties, obtained additional records, and toured the facility for the following complaints: COMPLAINT CONTROL NUMBER: 56-AS-20241101122704, CONTROL NUMBER: 56-AS-20241003123839, and CONTROL NUMBER: 56-AS-20240918162942.

Michelle Reyes was informed that additional time would be required to review the newly obtained information. Before delivering the findings.

An exit interview was conducted during which this report was discussed and provided to Marlene Delgado- Wellness Director along with appeal rights.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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