445294201-12-19-2023-26-AS-KHOS-D3GGJQ-20240318052328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445294201
Report Date: 12/19/2023
Date Signed: 12/19/2023 04:45:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2022 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20220622134812

FACILITY NAME:	ROSE GARDEN RCH		FACILITY NUMBER:	445294201
ADMINISTRATOR:	ORTIZ, CANDIE		FACILITY TYPE:	740
ADDRESS:	310 HATHAWAY AVENUE		TELEPHONE:	(831) 722-6346
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	6	CENSUS: 4	DATE:	12/19/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Candie Ortiz		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Residents are being left unattended while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo and Licensing Program Manager (LPM) Jackie Jin conducted an unannounced complaint investigation visit and met with Administrator Candi Ortiz.

On 06/22/2022, the Department received a complaint with the above allegation. An initial complaint investigation visit was conducted by LPA Ryker Heberle on 07/01/2022. LPA Marrufo obtained a copy of a Visit Report from an outside agency for a visit conducted on 06/16/2022.

The Visit Report stated that there was no manager at the time of visit. An outside agency reported to CCL that it received an anonymous tip that there were no staff at the facility on 06/21/2023. During visit, LPA Marrufo interviewed 3 out of 4 residents, and 1 resident was asleep during visit.

See LIC9099-C for more information. Page 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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 26-AS-20220622134812

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: ROSE GARDEN RCH	FACILITY NUMBER: 445294201
	VISIT DATE: 12/19/2023

NARRATIVE

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3 out of 3 interviewed residents stated that they did not recall a time during June 2022 when there were no staff attending to the residents at the facility.

Based on information from interviews and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegation is unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. This report was reviewed with Administrator Candie Ortiz and a copy of this report was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2