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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405801779
Report Date: 07/07/2021
Date Signed: 07/07/2021 03:40:33 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/04/2021 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20210304155748
FACILITY NAME:CASA ROSA ELDER CAREFACILITY NUMBER:
405801779
ADMINISTRATOR:ARPAD SOOFACILITY TYPE:
740
ADDRESS:2172 S. HALCYON ROADTELEPHONE:
(805) 473-0306
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:22CENSUS: 17DATE:
07/07/2021
UNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Zoltan Soo, Administrator and Lillyana Huerta, Office ManagerTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Facility did not provide a safe environment for residents.

Facility did not prepare and serve food in a safe and healthful manner.

Facility did not prominently display personal rights poster.
INVESTIGATION FINDINGS:
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On 7/07/2021 at 1:48 pm, Licensing Program Analyst (LPA) Chavez initiated a meeting to discuss the final findings for the allegations listed above. LPA met with Zolton Soo, Facility Administrator, and Lillyana Huerta, Office Manager, and informed both of the reason for the visit.

On the allegation “Facility did not provide a safe environment for residents”, the complainant’s concern was that exterior doors and the driveway gate were left open for extended periods of time and that memory care residents may be in danger of wandering from the property unattended. Further concerns were that the fireplace bricks were obtruding into the walkway. To investigate the allegation, LPA interviewed the complainant, the administrator, and residents and toured the facility, obtained photographs, and reviewed facility records.

Continued on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
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 2
Control Number 29-AS-20210304155748
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CASA ROSA ELDER CARE
FACILITY NUMBER: 405801779
VISIT DATE: 07/07/2021
NARRATIVE
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LPA toured the facility on 3/09/21 and 6/24/21. On both occasions, LPA encountered a closed and locked gate at vehicle entry. In the past three (3) years, there have been no reports of residents leaving the facility without supervision. The facility has an alert system upon entry and exit to doors. LPA viewed the bricks making up the outside décor of the fireplace. LPA found that the bricks extended out approximately six (6) inches from the front wall of the fireplace. Furniture in the room is set-up so that residents, staff, and guests can walk past the fireplace. LPA did not find that the bricks protruded in a way that caused a danger to anyone passing by the fireplace. In the past three (3) years, there have been no reports of injury or falls near the fireplace. Based on the information obtained, the allegation that, “Facility did not provide a safe environment for residents”, is Unsubstantiated.

On the allegation “Facility did not prepare and serve food in a safe and healthful manner”, the complainant showed concern that facility food was poorly prepared citing a time when a resident’s food was prepared at an improper temperature, and resident was unable to consume the item. To investigate the allegation, LPA interviewed residents about food quality. On 6/24/21, three (3) residents were interviewed at 3:08 pm, 3:15 pm, and 3:20 pm and on 7/07/21, one (1) resident was interviewed at 2:00 pm regarding food quality. All four residents stated that they ”enjoyed the food, it was a good variety, and there is more than enough” food served. LPA observed prepared food in the kitchen and found it to be of good quality. LPA interviewed the chef (S1) who explained that S1 prepares fresh food daily and typically prepares food for weekend staff to heat and serve. S1 states staff are trained on food preparation. Based on the information obtained, the allegation that, “Facility did not prepare and serve food in a safe and healthful manner”, is Unsubstantiated.

On the allegation “Facility did not prominently display personal rights poster”, the complainant noted that, on several occasions to the facility, the personal rights poster was not visible. To investigate the allegation, LPA toured the facility on two separate occasions, obtained photos, and spoke with staff. LPA observed resident personal rights posted on the bulletin board in the facility’s northwest hall leading to the office and resident rooms. The hall is in a common area where residents, visitors, and staff walk through. Based on the information obtained, the allegation that, “Facility did not prominently display personal rights poster”, is Unsubstantiated.

At 3:45 pm, an exit interview was conducted with Administrator Zolton Soo, and a copy of the report was given.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC9099 (FAS) - (06/04)
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