445294201-4-16-2024-26-AS-JJIN-D562TR-20240510174108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445294201
Report Date: 04/16/2024
Date Signed: 04/16/2024 04:47:53 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
12/28/2023 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20231228100948

FACILITY NAME:	ROSE GARDEN RCH		FACILITY NUMBER:	445294201
ADMINISTRATOR:	ROGERS, CANDIE		FACILITY TYPE:	740
ADDRESS:	310 HATHAWAY AVENUE		TELEPHONE:	(831) 722-6346
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	6	CENSUS: 4	DATE:	04/16/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Candi Rogers		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is unsanitary and malodorous
Staff left resident unattended in a dirty diaper for extended periods
Staff did not provide activities for resident
Staff did not give resident drinking water

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Christine Dolores and David Marrufo conducted an unannounced complaint investigation visit and met with Licensee/Administrator Candi Rogers.

The Department received a complaint on 12/28/2023 with the above allegations. An initial complaint investigation visit was conducted on 01/02/2024. Another complaint investigation visit was conducted on 03/13/2024. Throughout the investigation, the Department interviewed 4 out of 5 residents, 8 family members of residents, and 2 out of 2 co-licensees. One resident was not alert and oriented during visit when an interview was attempted. On the visit on 03/13/2024, LPA Marrufo toured and observed the facility and obtained copies of resident records.

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: 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.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 26-AS-20231228100948

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: 04/16/2024

NARRATIVE

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4 out of 4 interviewed residents stated the facility is not unsanitary and malodorous. 2 out of 2 interviewed co-licensees stated the facility is not unsanitary and malodorous. 4 out of 8 interviewed family members stated that facility is not unsanitary and malodorous and 4 out of 8 interviewed family members stated that the facility is unsanitary and malodorous.

4 out of 4 interviewed residents stated staff do not leave residents unattended in a dirty diaper for extended periods. 2 out of 2 interviewed co-licensees stated the staff do not leave residents unattended in a dirty diaper for extended periods. 6 out of 8 interviewed family members stated the staff do not leave residents unattended in a dirty diaper for extended periods. 2 out of 8 interviewed family members stated the staff do leave residents unattended in a dirty diaper for extended periods.

4 out of 4 interviewed residents stated staff do provide activities for residents. 2 out of 2 interviewed co-licensees stated staff do provide activities for residents. 6 out of 8 interviewed family members stated staff do provide activities for residents. 2 out of 8 interviewed family members stated staff do not provide activities for residents.

4 out of 4 interviewed residents stated staff do provide residents with drinking water. 2 out of 2 interviewed co-licensees stated staff do provide residents with drinking water. 6 out of 8 interviewed family members stated staff do provide residents with drinking water. 2 out of 8 interviewed family members stated that when both family members along with an additional family member were visiting their same family member who is a resident at the facility, they observed one of the co-licensees refuse their requests for the co-licensee to provide more water to their resident family member.

Based on information from interviews conducted 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 Licensee/Administrator Candi Rogers 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: 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

LIC9099 (FAS) - (06/04)

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