445294201-2-16-2024-26-AS-KHOS-D3GGVK-20240318054052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445294201
Report Date: 02/16/2024
Date Signed: 02/16/2024 05:11:26 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
02/21/2023 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20230221112958

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:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Candie Ortiz		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff left residents unattended for extended periods of time
Staff made inappropriate comments towards resident
Staff are using inappropriate ways to feed resident
Staff allowed resident to lay in bed for extended period of time
Staff used an inappropriate way to lift resident
Staff are not meeting residents hygiene needs
Staff did not provided adequate food service to residents
Staff left resident in soiled diaper for extended period of time
Staff are not making sure the facility is kept clean

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation and met with Administrator Candie Ortiz.

On 02/21/2023, the Department received a complaint with the above allegations. On 02/24/2023, LPA Marrufo conducted an initial complaint investigation visit. On 12/19/2023, LPA Marrufo conducted an additional complaint investigation visit. During the investigation, LPA Marrufo interviewed 3 residents, 3 family members of residents, one witness, and Administrator Candie Ortiz.

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: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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 3

Control Number 26-AS-20230221112958

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: 02/16/2024

NARRATIVE

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1 out of 3 interviewed residents stated to have observed staff leave residents unattended for extended periods of time. 2 out of 3 interviewed residents stated to have not observed staff leave residents unattended for extended periods of time. 3 out of 3 interviewed family members of residents stated to have not observed staff leaving residents unattended for extended periods of time. 1 out of 1 witness stated to have not observed staff leave residents unattended for extended periods of time. Administrator Candie Ortiz stated staff have not left residents unattended for extended periods of time.

3 out of 3 interviewed residents, 3 out of 3 interviewed family members of residents, 1 out of 1 interviewed witness, and Administrator Candie Ortiz stated to have not observed staff do any of the following: make inappropriate comments towards residents, use inappropriate ways to feed residents, allow residents to lay in bed for an extended period of time, use an inappropriate way to lift a resident, not meet residents’ hygiene needs, not provide adequate food service to residents, leave residents in soiled diapers for an extended period of time, not make sure that the facility is kept clean.

During visit on 12/19/2023, LPA Marrufo observed dinner meal service and meals being served to residents. Administrator Candie Ortiz stated that residents are able to ask for seconds.

During visit on 02/16/2024, LPA Marrufo observed 4 out of 4 residents. LPA Marrufo did not observe any signs of bad hygiene on the residents.

Based on information from interviews conducted with staff, residents, family members of residents, and a witness, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22

This report was reviewed with Administrator Candie Ortiz and a copy of this report was provided.

Page 2 of 2.

END REPORT

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
02/21/2023 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20230221112958

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:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Candie Ortiz		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff did not ensure resident was able to watch TV

INVESTIGATION FINDINGS:

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3 out of 3 interviewed residents, 3 out of 3 interviewed family members of residents, 1 out of 1 interviewed witness, and Administrator Candie Ortiz stated to have not observed staff not ensure that residents are able to watch television.

Based on information from interviews conducted with staff, residents, family members of residents, and a witness, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22

This report was reviewed with Administrator Candie Ortiz and a copy of this report was provided.

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: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3