Inspection Reports for Rosewood
1301 New Stine Rd, Bakersfield, CA 93309, CA, 93309
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, with the facility generally clean, well-maintained, and compliant with safety standards. However, some earlier reports cited deficiencies related to medication administration errors, documentation issues, and unsafe storage of items accessible to residents. A serious issue occurred in October 2021 when staff financially abused a resident and the facility failed to provide proper notice for fee increases. The most recent report from May 29, 2025, was a complaint investigation that found the complaint unfounded and no deficiencies. Several complaint investigations over time were unsubstantiated, and the facility appears to have improved since the more serious findings in 2021.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 166
Capacity: 220
Deficiencies: 0
May 29, 2025
Visit Reason
An unannounced complaint investigation was conducted following a complaint alleging rough handling of a resident causing injury and improper positioning of a resident in bed according to physician's instructions.
Findings
The investigation found that the resident in question had never resided in the facility, and the complaint was determined to be unfounded and dismissed.
Complaint Details
The complaint alleged staff handled a resident in a rough manner causing injury and did not position the resident in bed according to physician's instructions. The complaint was found to be unfounded.
Report Facts
Complaint Control Number: 24
Complaint Investigation Duration: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jimmy Duarte | Licensing Program Analyst | Conducted the complaint investigation |
| Rochelle Balaban | Administrator | Met with investigators during complaint investigation |
Inspection Report
Annual Inspection
Census: 138
Capacity: 220
Deficiencies: 4
Mar 25, 2025
Visit Reason
The inspection was an unannounced annual inspection conducted by Licensing Program Analysts to evaluate compliance with licensing requirements at Rosewood Retirement Community Facility.
Findings
The facility was generally found clean and in good repair with required equipment and supplies. However, deficiencies were cited in areas including Hospice Care for Terminally Ill Residents, Incidental Medical and Dental Care, Oxygen Administration, and Storage Space and Access.
Severity Breakdown
Type A: 2
Type B: 2
Deficiencies (4)
| Description | Severity |
|---|---|
| Medications and cleaning supplies were found accessible in resident rooms and memory care areas, posing immediate health and safety risks. | Type A |
| Medication administration errors were identified, including discrepancies in pill counts for residents R5 and R6. | Type A |
| The facility did not maintain current hospice care plans for residents R1, R2, and R3; deficiency was cleared during inspection. | Type B |
| Residents R4 and R5 on oxygen were unable to self-administer as required; updated physician reports were needed. | Type B |
Report Facts
Census: 138
Total Capacity: 220
Medication discrepancy: 2
Medication discrepancy: 1
Fire extinguisher service date: Mar 5, 2025
Fire safety inspection date: Jan 25, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Katie Brown | Licensing Program Analyst | Conducted inspection and signed report |
| Jimmy Duarte | Licensing Program Analyst | Conducted inspection |
| Rochelle Balaban | Administrator | Facility administrator met with LPAs during inspection |
| Sergiy Pidgirny | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 137
Capacity: 220
Deficiencies: 0
Mar 27, 2024
Visit Reason
An unannounced annual inspection visit was conducted to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be clean, in good repair, and well-maintained with no deficiencies cited during this visit. Residents reported satisfaction with their living situation, and safety measures such as locked chemicals and operational fire safety equipment were observed.
Report Facts
Residents observed in memory care unit: 8
Thermostat temperature: 73
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Darius Williams | Licensing Program Analyst | Conducted the unannounced annual inspection visit |
| Cille Caldwell | Director Assisted Living | Met with Licensing Program Analyst during inspection |
| Jesse Hernandez | Nurse Manager | Met with Licensing Program Analyst during inspection |
| Rochelle Balaban | Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Census: 136
Capacity: 220
Deficiencies: 0
Sep 28, 2023
Visit Reason
The visit was a Case Management in response to two Incident Reports submitted by the facility.
Findings
No deficiencies were cited during the visit. The Licensing Program Analyst reviewed resident records and discussed updated fall risk assessments to be conducted on two residents.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesus Hernandez III | Wellness Supervisor | Met with Licensing Program Analyst during the visit. |
| Rochelle Balaban | Administrator | Met with Licensing Program Analyst during the visit and reported plans for updated fall risk assessments. |
| Darius Williams | Licensing Program Analyst | Conducted the Case Management visit. |
Inspection Report
Capacity: 220
Deficiencies: 0
Aug 29, 2023
Visit Reason
The visit was a case management visit regarding a Decision and Order notice from the Caregiver Background Check Bureau (CBCB) requiring immediate action.
Findings
The notice required staff #1 to be immediately removed from the facility if present. The Administrator stated that the staff was not employed by the facility.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rochelle Balaban | Administrator | Met with Licensing Program Analyst to discuss case management visit and staff removal notice. |
Inspection Report
Annual Inspection
Census: 142
Capacity: 220
Deficiencies: 0
Apr 19, 2023
Visit Reason
An unannounced Annual Inspection visit was conducted to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be clean and in good repair across independent living, assisted living, and memory care units. All safety equipment was operational, employee and resident files were complete, and no deficiencies were cited at this time.
Report Facts
Employee files reviewed: 9
Resident files reviewed: 10
Perishable food storage duration: 2
Non-perishable food storage duration: 7
Refrigerator temperature: 36
Freezer temperature: -6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Darius Williams | Licensing Program Analyst | Conducted the annual inspection visit and authored the report |
| Rochelle Balaban | Administrator | Facility administrator present during inspection |
| Cille Caldwell | Director of Assisted Living | Facility director present during inspection |
Inspection Report
Census: 157
Capacity: 220
Deficiencies: 0
Jul 1, 2022
Visit Reason
The inspection was an unannounced case management - other visit conducted to perform a health and safety check and review the facility's signal system and SafelyU fall detection program.
Findings
No deficiencies were cited during the inspection. Observations were made and staff were interviewed regarding the facility's safety systems.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rochelle Balaban | Administrator | Met with Licensing Program Analyst during inspection and received the report. |
| Cille Caldwell | Director of Assisted Living | Met with Licensing Program Analyst during inspection. |
| Malia Thao | Licensing Program Analyst | Conducted the inspection. |
| Melinda Hoffmann | Licensing Program Manager | Named in report header. |
Inspection Report
Annual Inspection
Census: 151
Capacity: 220
Deficiencies: 0
Mar 21, 2022
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and COVID-19 guidelines at the facility.
Findings
No deficiencies were cited during the inspection. The facility was found to have proper infection control measures, medication management, and emergency contact updates in place.
Report Facts
Capacity: 220
Census: 151
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Malia Thao | Licensing Program Analyst | Conducted the annual inspection |
| Cille Caldwell | Director of Assisted Living | Met with Licensing Program Analyst during inspection |
| Rochelle Balaban | Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Census: 151
Capacity: 220
Deficiencies: 0
Nov 10, 2021
Visit Reason
The inspection was an unannounced case management - other inspection conducted by Licensing Program Analyst Malia Thao to amend a Plan of Correction for a deficiency issued on 10/18/21.
Findings
No deficiencies were cited during the inspection. The Plan of Correction was amended as part of this visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rochelle Balaban | Administrator | Met with Licensing Program Analyst during inspection. |
| Faith Enriquez | Lead LVN | Met with Licensing Program Analyst during inspection. |
Inspection Report
Complaint Investigation
Census: 151
Capacity: 220
Deficiencies: 1
Nov 3, 2021
Visit Reason
The visit was an unannounced case management inspection conducted to deliver findings on complaint allegations and to investigate the complaint.
Findings
During the investigation, Licensing Program Analysts toured the facility, reviewed medication carts, staff training records, and documentation. Technical Violations were issued for some regulations, and Technical Assistance was provided for hospice care plans and other areas. No deficiencies were cited on this case management inspection.
Complaint Details
The visit was triggered by complaint allegations. Technical Violations were issued, but no deficiencies were cited during the inspection.
Deficiencies (1)
| Description |
|---|
| Technical Violations for California Code of Regulations (CCR), Title 22, Division 6 |
Report Facts
Capacity: 220
Census: 151
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rochelle Balaban | Executive Director | Met during the inspection and exit interview |
| Griscel Garcia | Manager of Memory Care | Met during the inspection and exit interview |
Inspection Report
Census: 151
Capacity: 220
Deficiencies: 3
Nov 3, 2021
Visit Reason
The inspection visit was an unannounced case management - deficiencies inspection conducted to evaluate compliance with regulatory requirements.
Findings
The inspection identified several deficiencies including unsafe storage of a steak knife and disinfecting spray accessible to residents, a resident with dementia lacking a recent medical assessment, and a resident's medical assessment missing primary and secondary diagnoses.
Severity Breakdown
Type A: 1
Type B: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Steak knife out on the counter in the kitchen of the third floor, unsupervised, and disinfecting spray bottle accessible to residents in Room 244. | Type A |
| Resident R2 diagnosed with dementia had last medical assessment completed on 2/20/2020, not meeting annual assessment requirements. | Type B |
| Resident R6's medical assessment form LIC602A did not include the resident's primary or secondary diagnosis. | Type B |
Report Facts
Capacity: 220
Census: 151
Plan of Correction Due Date: 11
Plan of Correction Due Date: 17
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rochelle Balaban | Administrator | Met during inspection and mentioned in report |
| Faith Enriquez | Lead LVN | Observed during inspection in relation to deficiency findings |
| Malia Thao | Licensing Program Analyst | Conducted inspection and cited deficiencies |
| Andy Xiong | Licensing Program Manager | Supervisor named in report |
Inspection Report
Complaint Investigation
Census: 151
Capacity: 220
Deficiencies: 2
Nov 3, 2021
Visit Reason
An unannounced complaint investigation was conducted based on allegations that facility staff were not administering medication as prescribed and were not meeting resident needs.
Findings
The investigation substantiated that facility staff failed to administer medication as prescribed, specifically noting missed doses of Acetaminophen for one resident. Additionally, 3 out of 8 residents sampled had Activities of Daily Living logs that did not match their basic services as documented. Other complaints regarding pressure injuries and emergency call buttons were found to be unfounded.
Complaint Details
The complaint investigation was substantiated for medication administration and ADL documentation deficiencies. Other allegations regarding stage 2 pressure injuries and emergency call button access were found to be unfounded and dismissed.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility staff were not administering medication as prescribed, with missed doses of Acetaminophen noted. | Type A |
| Activities of Daily Living (ADL) logs for 3 out of 8 residents did not match the residents' basic services as shown on the Physician's Report. | Type B |
Report Facts
Resident census: 151
Total capacity: 220
Missed medication doses: 7
Residents sampled: 8
Residents with ADL discrepancies: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rochelle Balaban | Administrator | Met with Licensing Program Analysts during investigation |
| Griscel Garcia | Memory Care Manager | Met with Licensing Program Analysts during investigation |
| Malia Thao | Licensing Program Analyst | Conducted complaint investigation |
| Lisa Salazar | Licensing Program Analyst | Conducted complaint investigation |
| Andy Xiong | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 153
Capacity: 220
Deficiencies: 2
Oct 18, 2021
Visit Reason
Unannounced complaint investigation visit conducted due to allegations of facility staff financially abusing a resident and increasing a resident's rate without proper notice.
Findings
The investigation substantiated that staff member S1 financially abused resident R1 by receiving checks from them, and the facility increased R1's monthly fee for January and February 2021 without providing the required 60 days advance written notice.
Complaint Details
Complaint was substantiated based on evidence that staff financially abused a resident and the facility failed to provide proper notice for fee increases.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility staff financially abused resident by receiving checks from the resident. | Type B |
| Facility increased resident's monthly fee without proper 60 days advance written notice. | Type B |
Report Facts
Census: 153
Total Capacity: 220
Deficiencies cited: 2
Plan of Correction Due Dates: Dec 10, 2021
Plan of Correction Due Dates: Nov 1, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rochelle Balaban | Administrator | Met with Licensing Program Analyst during investigation |
| Malia Thao | Licensing Program Analyst | Conducted the complaint investigation |
| Andy Xiong | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Census: 142
Capacity: 220
Deficiencies: 0
May 3, 2021
Visit Reason
The inspection visit was conducted as a health and safety check under Case Management - Other to evaluate the facility's compliance with health and safety standards.
Findings
No immediate health and safety concerns were observed during the tour of the facility, and no deficiencies were found.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cille Caldwell | Director of Assisted Living | Met with Licensing Program Analyst during inspection and received report. |
| Rochelle Balaban | Administrator | Met with Licensing Program Analyst during inspection. |
| Malia Thao | Licensing Program Analyst | Conducted the health and safety check inspection. |
| Andy Xiong | Licensing Program Manager | Named in the report header. |
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