435200967-5-14-2024-26-AS-JJIN-D6MVGR-20240627162558

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200967
Report Date: 05/14/2024
Date Signed: 05/14/2024 03:32:58 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/19/2022 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220119152329

FACILITY NAME:	ROSE GARDEN COURT		FACILITY NUMBER:	435200967
ADMINISTRATOR:	ROSETE, LILETTE		FACILITY TYPE:	740
ADDRESS:	958 VERMONT STREET		TELEPHONE:	(408) 247-0815
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	30	CENSUS: 12	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	12:49 PM
MET WITH:	Michael Rosete		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not seek resident medical attention in a timely manner.

INVESTIGATION FINDINGS:

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On 5/14/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Co-Administrator (CAD) Michael Rosete and LPA explained the purpose of today's visit.

Regarding the allegation of staff did not seek resident medical attention in a timely manner, reporting party (RP) stated that resident R1 has a fever of 101, with cough/congestion since Sun/Mon 1/16-17 and sending R1 to the hospital for evaluation and treatment.

LPA visited the facility and interviewed CAD. CAD stated that there was no covid positive residents or staff in the facility during this time. There was an incident report submitted to Licensing that at 6:30 am on 1/18/22 R1 has non stop coughing, 911 was called immediately and R1 got transported the hospital. R1 was not tested in the facility for covid. Prior to 1/18/22, R1 didn’t have any symptoms nor was sick.

Based on interviews and records review, the department has determined that that the allegation is false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED.

Report is reviewed and copy is provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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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