374603871-1-10-2025-18-AS-VMIN-DCSRXY-20250110122530

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603871
Report Date: 01/10/2025
Date Signed: 01/10/2025 12:25:36 PM

Document Has Been Signed on 01/10/2025 12:25 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
RIVERSIDE, CA 92507

FACILITY NAME:	ROSE GARDEN		FACILITY NUMBER:	374603871
ADMINISTRATOR/ DIRECTOR:	CORPUZ, ROLANDO		FACILITY TYPE:	740
ADDRESS:	1266 PLEIADES DR		TELEPHONE:	(760) 659-6397
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 0	CENSUS: 15	DATE:	01/10/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:00 AM
MET WITH:	ADMINISTRATOR, ROLANDO CORPUZ		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On January 10, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and met with the Administrator, Rolando Corpuz. The facility file review was conducted in the office and additional forms were reviewed on site. LPA Mixson toured the facility along with the Administrator, Rolando Corpuz and inspected the facility inside and outside. There were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single story home. With multiple buildings, located at 1266 Pleiades Dr, Vista, CA 92084. Physical Plant: The facility phone number is (760)659-6397 and is operable. LPA observed the residents’ bedrooms, and they are equipped with required furniture as per Title 22. LPA inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the resident and staff files. Medications: were reviewed, locked and inaccessible to residents, and there was a 30-day supply for each resident receiving medication. The overall facility is clean, and the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit.

Jazmond D Harris	TELEPHONE: (951) 248-0318
Venus Mixson	TELEPHONE: (951) 897-7936
	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ROSE GARDEN	FACILITY NUMBER: 374603871
	VISIT DATE: 01/10/2025

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Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly.

Care & Supervision Facility has sufficient staff, three staff at the time of this visit. Administrator's new certificate has an expiration date of 08/01/2026.

Records Review: LPA reviewed resident files and staff files, and conducted staff and resident interviews. Files contained the required documents as per regulations.

Previous Community Care Licensing forms were reviewed.
There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit.

An exit interview was conducted and a copy of this report was given to the Administrator, Rolando Corpuz.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC809 (FAS) - (06/04)

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