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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445294201
Report Date: 04/30/2024
Date Signed: 04/30/2024 01:24:53 PM


Document Has Been Signed on 04/30/2024 01:24 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:
04/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Candie Rogers and Librada "Lee" NajeraTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Christine Dolores, David Marrufo, Manuel Monter, and Simi Rai, Licensing Program Manager (LPM) Jackie Jin, and Regional Manager (RM) Vivien Helbling conducted an unannounced Case Management visit.

The purpose of the visit was to deliver a Temporary Suspension Order (TSO) to the facility licensees, Candie Rogers (aka Candie Ortiz) and Librada "Lee" Najera. The TSO notified the Licensees that the facility will be closed immediately and the residents will be relocated.

Representatives from law enforcement, Santa Cruz County Adult Protective Services, and Santa Cruz County Long-Term Care Ombudsman were present during visit as well. All agencies collaborated to support and assist in resident relocation.

During visit, LPAs observed the facility retained expired medications for residents R1-R3 and for four former residents. A firearm was found in an open safe in the unlocked facility garage. Residents R1, R3, and R4 have dementia. The facility license was removed from the facility.

Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D for more information.

This report was reviewed with Candie Rogers and a copy of this report provided. A TSO was issued and Accusation and Notice of Defense were explained.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
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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Document Has Been Signed on 04/30/2024 01:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/01/2024
Section Cited
CCR
87465(i)

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87465(i) Incidental Medical and Dental Care: Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor
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The Department has issued a TSO. The facility will be closing immediately today. Residents are being relocated.
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retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. This requirement was not met as evidenced by: Licensee did not ensure that expired medications for residents R1-R3 and four former residents were destroyed, which poses an immediate safety risk to residents in care.
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Type A
05/01/2024
Section Cited
CCR87309(a)(1)

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87309(a)(1) Storage Space: (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
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The Department has issued a TSO. The facility will be closing immediately today. Residents are being relocated.
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 (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement was not met as evidenced by: Licensee did not ensure that a firearm held in the facility was in a locked storage area, which poses an immediate safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/30/2024 01:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/01/2024
Section Cited
CCR
87705(f)(1)

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87705(f)(1) Care of Persons with Dementia: The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement was not met as evidenced by:
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The Department has issued a TSO. The facility will be closing immediately today. Residents are being relocated.
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Licensee did not ensure that a firearm stored in the facility was stored inaccessible to residents at the facility with dementia.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
LIC809 (FAS) - (06/04)
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