Inspection Reports for
The Rose Garden Elderly Care

The facility was observed to be non-operational with no residents present. The Administrator submitted the original license and was informed about the closure process. A Type B deficiency was cited for failure to notify the resident's responsible person as required by Health and Safety Code section 1569.683(b).

The inspection found one deficiency related to inaccurate centrally stored medication forms for 2 residents, posing a potential health, safety, or personal rights risk. The facility otherwise met requirements for environment, safety equipment, and emergency preparedness.

The complaint alleged that staff hit residents and spoke to residents in an inappropriate manner. Interviews revealed no evidence of staff hitting residents; some residents reported a male staff yelling, but the facility has no male staff. The administrator and staff denied any abuse or yelling. The investigation concluded the allegations were unsubstantiated.

After interviews with residents, staff, and the administrator, and review of physician reports and facility records, the Department found the allegations unsubstantiated due to lack of preponderance of evidence. No citations were issued during the investigation.

The complaint alleged that staff left resident R1 soiled for an extended period. Multiple witnesses provided conflicting observations. Interviews with staff and residents indicated regular checks and timely care. The resident in question no longer resides at the facility. The investigation concluded the allegations were unsubstantiated.

Based on interviews, observations, and records review, there was insufficient evidence to substantiate the allegation that a resident was left soiled for an extended period. The allegations were determined to be unsubstantiated.

The visit was triggered by a complaint investigation. The deficiencies related to failure to notify the Department about hospice care initiation and incomplete resident care plans. The report does not explicitly state substantiation status.

The investigation found that the facility administrator failed to notify the Department in writing within five working days of the initiation of hospice care services for a resident, and the resident's Appraisal/Needs and Services plan was incomplete and unsigned. These deficiencies posed potential health, safety, or personal rights risks to residents.

The complaint investigation was substantiated for the allegation that staff yelled at a resident, posing a potential health and safety risk. The allegation that staff hit a resident was unsubstantiated due to insufficient evidence.

The allegation that staff yelled at a resident regarding non-payment of fees was substantiated and found to pose an immediate health and safety risk. The allegation that staff hit a resident was unsubstantiated due to lack of evidence.

No deficiency was cited during the visit based on California Code of Regulations Title 22; however, a repeat violation was amended. Chemicals were observed accessible to residents in multiple areas, posing an immediate health and safety risk, and a plan of correction was requested.

During the visit, a bar cart with over 6 bottles of alcohol was found accessible to residents with dementia, posing an immediate health and safety risk. The alcohol was removed and secured, and the administrator agreed to ensure alcohol remains inaccessible to residents with dementia.

Multiple deficiencies were cited including accessible chemicals and knives posing safety risks, unlabeled medications, incomplete medication logs, lack of PRN medication logs, missing disaster drill documentation, and outdated medical assessments for residents with dementia. A civil penalty of $250 was assessed for a repeat violation.

No deficiencies were cited during the visit. The Licensing Program Analyst interviewed the administrator and a staff member, confirming the administrator's recent start date and knowledge of resident care plans.

The complaint alleged staff were not meeting residents' dietary needs, not providing adequate food service, and leaving a resident in a soiled diaper overnight. Interviews with residents, staff, and the administrator, as well as observations, did not provide sufficient evidence to substantiate these allegations. The complaint was determined to be unsubstantiated.

The investigation found sufficient food supply and accommodations for residents' dietary needs, with staff providing additional servings upon request. Residents and staff interviews indicated that toiletry needs were met regularly. However, one resident reported insufficient food variety and occasional delays in assistance. Overall, there was insufficient evidence to substantiate the allegations, and the complaint was unsubstantiated.

The inspection found multiple deficiencies including unclean conditions such as full trash bins causing foul odors, improperly secured disinfectants and medications, hot water temperature exceeding regulatory limits, lack of CPR and first aid certification for staff, missing resident appraisal/needs and services plans, and incomplete medication records.

The facility was found to be in good repair with functioning smoke detectors, fire extinguisher, clean and furnished resident bedrooms, and safe bathrooms. The facility currently has no residents or staff aside from the licensee. Licensure is recommended pending creation of an emergency key set, obtaining liability insurance, and adjustment of water temperature to between 105°F and 120°F.

The applicant and administrator successfully completed Component II of the licensing process, demonstrating understanding of facility operation, staff qualifications, training, grievance procedures, food service, medication management, and reporting processes. No deficiencies were noted.