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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850358
Report Date: 09/19/2023
Date Signed: 09/19/2023 05:29:37 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2023 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20230912143940
FACILITY NAME:ROSE GARDEN MANORFACILITY NUMBER:
565850358
ADMINISTRATOR:SORATORIO, AMALIAFACILITY TYPE:
735
ADDRESS:1731 S. VENTURA ROADTELEPHONE:
(805) 890-0607
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 6DATE:
09/19/2023
UNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Amalia SoratorioTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff mismanaged residents' medication
Uncleared adults on the premises
Untrained staff
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted a 10-Day initial complaint visit to the facility at 01:38 p.m. The LPA was greeted by Caregiver Maria Fababier and the reason for the visit was explained. Administrator Amalia Soratorio arrived shortly after.

Today, the LPA and Caregiver Maria toured the facility at 1:45 p.m. The LPA conducted two (2) staff, two (2) client interviews, interviewed the administrator, conducted a file review and medication audit between 2:50 p.m. and 5:00 p.m.

On the allegation that staff mismanaged residents’ medication, it is the reporting party’s concern that medications have been left out, unsecure, and that the administrator gives medications to persons outside the facility.
Report will continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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 3
Control Number 29-AS-20230912143940
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROSE GARDEN MANOR
FACILITY NUMBER: 565850358
VISIT DATE: 09/19/2023
NARRATIVE
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To investigate the allegation, the LPA conducted a medication audit for three (3) out of six (6) clients. Medications are centrally stored and locked in a cabinet in the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record, and all medications were accounted for. The LPA did not observe any unsecured medications during the facility tour. In addition, staff and administrator interviews revealed that medications are always verified and given to the client they are intended for. The administrator Amalia further revealed that event though all staff receives medication training only three staff (S1, S2, S3) pass out medication, and that new staff are not allowed to pass medications until a year of employment to prevent medication errors. Lastly, the administrator stated that she has not and cannot give medications to anyone other than the clients. Based on interviews and record review the allegation above is deemed unsubstantiated at this time.
Uncleared adults on the premises
On the allegation that there is uncleared adults on the premises, it is the concern of the reporting party that staff without background clearance are working at the facility. To investigate the allegation, the LPA requested staff’s records for the staff reflected on the LIC500 (Personnel Roster). The LPA reviewed records and the reviewed records revealed that all staff members were background cleared and are associated with this facility. Staff and administrator interviews confirmed there are no other adults who work at the facility other than those on the staff schedule. Administrator also confirmed that there are no other adults that reside on the premises other than the clients. Client interviews further revealed they have not seen any other adults working in the facility other than the regular staff. Based on interviews and record review the allegation above is deemed unsubstantiated at this time.

Untrained staff


On the allegation that there is untrained staff, it is the reporting party’s concern that staff are working with residents and have not been properly trained. To investigate the allegation, the LPA conducted staff record review, and interviewed staff and the administrator. The record review revealed that all staff received initial training and continue to receive annual training. The Administrator interview revealed that the staff receives orientation training, continuation on-site training and Direct Support Professional Training. Staff interviews revealed that they received training in Direct Support Professional training and on-site training. Based on interviews and record review the allegation above is deemed unsubstantiated at this time.

No deficiencies were observed. Exit interview conducted and report issued to Administrator Amalia Soratorio.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3