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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445294201
Report Date: 04/16/2024
Date Signed: 04/16/2024 04:47:02 PM


Document Has Been Signed on 04/16/2024 04:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 RCHFACILITY NUMBER:
445294201
ADMINISTRATOR:ROGERS, CANDIEFACILITY TYPE:
740
ADDRESS:310 HATHAWAY AVENUETELEPHONE:
(831) 722-6346
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:6CENSUS: 4DATE:
04/16/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Candie RogersTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPAs) David Marrufo and Christine Dolores arrived unannounced to conduct the facility’s case management – legal / non-compliance visit. LPAs met with Administrator/Licensee, Candie Rogers.

The purpose of the visit is to ensure that the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) after a non-compliance conference held on 11/14/2023.

During visit, LPAs requested for the facility’s training documentation based on the compliance plan. Administrator was unable to produce the training documentations. The Administrator states the training are verbally being discussed with the Administrator and staff; however, they do not document the training discussions. Trainings that were discussed includes topics such as contacting 911, dementia, Alzheimer’s, and personal rights. Administrator was advised to document the trainings discussed between Administrator and any applicable staff. The Administrator states the next training is scheduled for May 2024.

LPAs observed the 4 out of 4 auditory door alarms were operable. The Administrator demonstrated how to operate 4 out of 4 door alarms. LPAs reviewed the facility’s nightly checks on residents, nightly checks on door alarms and doors, and monthly alarm inspections logs are being completed since December 2023 – current.

LPAs reviewed 4 out of 4 resident’s physician’s reports and appraisal/needs and services plan are up to date. LPAs reviewed the facility’s protocols and procedures on topics such as training, personal rights, medical assessments, reappraisals, contacting emergency personnel, elopements, criminal background checks, and volunteers. No deficiencies were cited per Calfiornia Code of Regulations, Title 22. This report was reviewed with Administrator/Licensee Candie Rogers and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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