374604115-7-26-2022-08-AS-LTEZ-CGRPSA-20220728113355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604115
Report Date: 07/26/2022
Date Signed: 07/26/2022 04:40:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2021 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20211207090521

FACILITY NAME:	COUNTRY ROSE ESTATE MEMORY CARE		FACILITY NUMBER:	374604115
ADMINISTRATOR:	PARAISO, CATHERINE T		FACILITY TYPE:	740
ADDRESS:	1255 ADVENTURE LN		TELEPHONE:	(760) 738-9391
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92069
CAPACITY:	15	CENSUS: 14	DATE:	07/26/2022
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Caregiver, Yuri Ramirez Olvera		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Licensee does not meet general food requirements.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to coduct additional interviews and deliver findings regarding the mentioned allegation. The LPA was greeted by Caregiver, Yuri Ramirez Olvera, identified himself, and disclosed the purpose of the visit.

Throughout the investigation, the LPA toured the facility, reviewed staff records, resident records, and conducted interviews with residents, staff, and outside sources.

It was alleged the licensee did not meet general food requirements. Interviews with staff revealed the facility has a staff designated to cook meals throughout the week. Meals prepared during the morning shift are then served by staff during each shift. Snacks are also available to the residents throughout the day. Interviews with residents corroborated the meals provided are of good quality, and options are often offered to residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 380-3797
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 755-7595
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

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 08-AS-20211207090521

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: COUNTRY ROSE ESTATE MEMORY CARE	FACILITY NUMBER: 374604115
	VISIT DATE: 07/26/2022

NARRATIVE

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An interview with an outside source confirmed the facility to be well stocked with food items, and the residents expressing the food provided was adequate, on multiple visits. An ample amount, and variety of food was witnessed by the LPA on multiple visits conducted to the facility throughout the investigation. Contradicting interviews revealed staff are occasionally unable or unwilling to provide additional options, but residents are also able to obtain their own meals.

Based on the evidence gathered throughout the investigation, there is not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegation is unsubstantiated.

Administrator, Val Paraiso, was called and notified of the findings.

An exit interview was conducted with Caregiver, Yuri Ramirez Olvera, to whom a copy of this report and Licensee's Rights (LIC 9058 01/16) were provided to.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 380-3797
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 755-7595
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

LIC9099 (FAS) - (06/04)

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