The Rose Garden Elderly Care

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management visit to conduct a facility closure tour. LPA met with Administrator ADM) Tingxiu Li. LPA toured the facility inside and out. LPA did not observe any resident at the facility. The facility was observed at a non-operational status. ADM submitted the original license. LPA explained the closure process to ADM. Exit interview was conducted with ADM. The report was provided to ADM for review and signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Feb 3, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.683(b) · Plan of correction due date: Feb 10, 2026

Health and Safety Code section 1569.683 (b) The licensee, in addition to either serving a 30-day notice, or seeking approval from the department and serving three days notice, on the resident, shall notify, or mail a copy of the notice to quit to, the resident's responsible person. This requirement was not met as evidenced by: Based on the interview and records reviewed, the Department received a formal written letter of closure via email on 1/31/2026 and the facility plans to close on 1/31/2025, and the Department did not receive the facility closure plan which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee stated he/she will read and certify understanding of HSC 1569.683(b) by POC due date. Licensee agreed and understood. Licensee agreed to send plan of correction by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Tingxiu Li. LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility. 4 residents and 2 staff were observed in the facility. LPA reviewed 2 resident file and 2 staff files. Family room, living room, kitchen, dining area, 2 restrooms, a office, and garage were inspected. 4 resident bedrooms were inspected. Two staff room was observed in the facility. 4 beds with bed rails were observed in the residents rooms. ADM stated the residents have the document for bed rails. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The temperature of the freezer was observed at 0 degree F, and the temperature of the refrigerator was observed at 37 degree F. Medication closet, knives closet, and chemical closet were observed locked. Room temperature was at 76 degree F, and hot water temperature was at 107 degree F in facility. Fire extinguisher was serviced on 5/20/2025. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by ADM, and were working. First aid box, night lights, and flash lights were observed in the facility. Front yard and backyard were inspected. There was no obstruction to block the walkways. A storage room was observed at backyard. The last time the facility conducted the emergency and fire drill was on 6/1/2025. Deficiency noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Jul 7, 2025

Allegation investigated: Staff hit resident. Staff spoke to resident(s) in an inappropriate manner.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with staff Noemi Velasquez (NV). On 01/17/2025, the Department received a complaint with the allegations that staff hit residents and staff spoke to residents in an inappropriate manner. On 1/24/2025, the Department conducted an initial investigation visit. LPA interviewed Administrator, a staff S1, and 2 residents (R1, R2). LPA obtained the physician reports of R1 and R2. LIC500 personnel report, Register of facility residents Continue on LIC9099-C. Page 1 of 3. Unsubstantiated Staff hit resident: Staff spoke to resident(s) in an inappropriate manner: The allegations are resident hit by staff and staff yelled at resident. On 1/24/2025, LPA interviewed 2 residents. One resident was unable to answer the questions. The other residents stated there was no staff hit him/her, and no female staff yelled at him/her but a male staff yelled at him/her. LPA interviewed staff S1. S1 denied he/she hit or physical abused residents. S1 stated some of residents are with bad hearing, so he/she sometimes raised the voice but he/she never yelled at residents. S1 stated he/she did not see or hear any staff hit or yelled residents. LPA interviewed Administrator (ADM). ADM denied staff hit or yelled at residents. ADM stated he/she did not receive any report that staff hit or yelled at residents. ADM stated some residents with bad hearing, the staff might need to raise voice to talk to them, but were not yelling at the residents. ADM stated on 12/17/2024, around 1;00PM, resident R1 was transferred from a skilled nursing home to the facility via ambulance. ADM stated R1 was combative and did not want to move in the facility. ADM stated R1's family member and two staff of the ambulance were helping R1 to move in the facility, and were talking loud to R1 because R1 was behaving aggressively. ADM stated neighbors called police department. ADM stated police officers came to the facility but did not leave police report case number. LPA toured the backyard and side yard, LPA observed the fences are around 2 meters. It was hard to look though the fence to see the inside of the facility. LPA noted that It is easy to hear the voice at the side yard in the neighborhood for the conversation in the facility if windows are opened On 1/25/2025, LPA interviewed resident R2's family member (FM). FM stated the facility staff treat R2 very good. FM stated R2 received good care from the facility staff. FM stated the facility staff did not yell or hit at R2. Continue on LIC9099-C. Page 2 of 3. On 1/25/2025, LPA called R1's previous skilled nursing home and left message, LPA did not receive any call back. On 1/25/2025, and 1/27/2025, LPA called resident R1's family member and left message to call back. LPA did not receive any call back. Based on the review of R1 and R2's physician reports, both have cognitive impairment. LPA reviewed the facility staff roster, the facility does not have male staff. Based on the review of R1's physician report, R1 has aggressive behavior and inappropriate behavior. Based on the interview, observation, and record reviewed, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. No citations noted at today’s compliant investigation visit. Exit interview conducted with NV. The report was provided to NV for review and signature. A copy of this report was provided to NV. Page 3 of 3.,the state’s words, verbatim · CDSS document, May 30, 2025 · control 26-AS-20250117162513

Allegation investigated: Staff left a resident soiled for an extended period of time.

Licensing Program Analyst (LPA) Manuel Monter & Kenneth Madrigal conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Staff Noemi Velasquez. On January 10, 2025, the Department received a complaint alleging Staff left a resident soiled for an extended period of time. It has been alleged that resident R1 was left soiled for an extended period of time. On January 14 & 15, 2025, LPA Monter interviewed Witness W1 and W2. W1 stated he/she has been to the facility on 3 different occasions. W1 stated he/she witnessed resident R1 in a soiled state with a strong odor, on January 5th, 2025. W1 stated he/she informed facility staff of R1’s soiled state and staff changed the resident. W1 stated he/she did not note R1 in a soiled state the other 2 times he/she visited R1 at the facility. W2 stated he/she visits the facility at least 2 times a week. W2 stated he/she has never observed R1 unchanged or his/her bedding in a soiled state. Page 1 Out of 3. Unsubstantiated On January 17, 2025, LPA’s conducted an unannounced complaint investigation visit. LPA Manuel Monter and Marcela Yanez interviewed ADM Tingziu Li. ADM stated her staff are instructed to check residents every 2 hours, to see if they are soiled. ADM stated if residents are observed soiled, then staff will change them. ADM stated she has never observed residents left in a soiled state. LPA Manuel Monter and Marcela Yanez interviewed resident R2. R2 stated the staff does check up on him/her. R2 stated the staff does assist him/her with changing and using the restroom. R2 stated he/she hasn’t seen other residents in a soiled or in a disheveled. The Department was unable to interview resident R1, who no longer lives at the facility. On January 22, 2025, LPA Monter interviewed Witness W3. W3 stated he/she visits the facility everyday, multiple times a day. W3 stated, on an unspecified date, he/she observed resident R1 with a soiled diaper. W3 stated he/she asked staff S1 to change resident R1, but W3 , S1 told him/her that he/she would not change R1 because the home health aide was arriving at the facility soon. W3 stated he/she left the facility 15 minutes later, and the home health aide did not arrive by the time W3 left the facility. On January 27, 2025, LPA Monter interviewed Witness W4 & W5. W4 stated he/she only visited the facility on 2 occasions. W4 stated he/she has not observed resident R1 in a soiled state or his/her bedding in a soiled state or with odor. W5 stated he/she visited the facility initially 3x a week, which increased to 5x a week. W5 stated there was 3 instances (December 27th 2024, January 6 & 8 2025), where he/she found R1 in a soiled state, but stated he/she was unsure how long R1 was left soiled. W5 stated he/she didn't inform facility staff or ADM that he/she found R1 in a soiled state. On January 31, 2025, Licensing Program Analyst Manuel Monter interviewed staff S1. S1 stated, he/she checks the residents every 2 hours. S1 stated he/she will change the residents if he/she observes them soiled or if family members inform him/her that a resident is soiled. S1 stated he/she has never left a resident soiled and stated he/she ensure the residents sheets are changed if soiled as well. Page 2 Out of 3. On January 17 and 31, 2025, LPA toured the facility inside and out. LPAs did not observe any residents that were unhygienic / dirty or unkempt. LPA’s did not observe any bedding with stains or odor during visit. Based on the interviews conducted & records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED This report was reviewed with ADM Tingxiu Li via phone call. ADM stated Staff Noemi Velasquez could sign on her behalf. A copy of the report was provided. Page 3 Out of 3. END OF REPORT.the state’s words, verbatim · CDSS document, Jan 31, 2025 · control 26-AS-20250110122127

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Manuel Monter and Marcela Yanez arrived unannounced to open a complaint investigation. During the complaint investigation, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met with Administrator Tingxiu Li. During investigation, LPAs asked ADM if she notified the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. ADM stated she did not. LPAs reviewed resident R1's Appraisal/Needs and Services plan (ANS), dated December 1, 2024. Based on a review, this ANS does not detail the residents background, or the needs/plan to address the residents needs. This ANS is also not signed by the resident/residents responsible party. ADM stated the resident is on hospice and the hospice nurse did not fill the ANS out. LPAs discussed with ADM the importance of reporting the initiation of hospice services to Community care licensing. LPA's discussed with ADM, that prior to the resident moving in, the facility must ensure, the residents ANS is filled out and addresses the residents needs, and the facility's plan/object to meet that residents needs. LPAs discussed PIN 22-24-ASC Collaborating With Home Health Agencies and Hospice Agencies To Provide Care To Residents. LPAs provided CCL flyer for important updates to Dementia Care and Miscellaneous changes. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with ADM Tingxiu Li. A Copy of the report was provided, alongside Appeal rights.the state’s words, verbatim · CDSS document, Jan 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87632(d)(2) · Plan of correction due date: Jan 24, 2025

87632 Hospice Care Waiver (d)(2) The licensee shall notify the Department... initiation of hospice care services... five working days of admitting a resident already receiving hospice care services... This requirement was not met as evidenced by; Based on record review and interview, facility ADM stated she did not notifiy the deparment of the initiation of hospice care services for R1. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 17, 2025

Plan of correction: ADM stated she will send a letter of understanding regarding the hospice waiver stipualtions, such as notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of ... admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. ADM stated she will send the plan of correction by POC date, 1/24/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Jan 24, 2025

87463 Reappraisals (a) The pre-admission appraisal, ... shall be updated in writing as frequently as necessary ...to note significant changes in condition,... to keep the appraisal accurate.... This requirement was not met as evidenced by; Based on record review , resident R1's Needs and services plan was not filled out. ADM stated the care plan was not filled out because, hospice nurse didn't fill it. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 17, 2025

Plan of correction: ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send the plan of correction by POC date, 1/24/25.

Allegation investigated: - Staff yelled at resident

On 12/10/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver findings regarding the allegation received. LPA met with staff Noemi Velasquez and explained te purpose of today's visit. During the investigation interviews were conducted and facility observations were made. It's discovered through interviews that there has been witnessed accounts of S1 yelling at a resident. Per interviews the main reason for the yelling has been in regards to facility fees and the non-payment of the fees by R1. Based on the interviews the preponderance of evidence standard has been met. This poses a potential health and safety risk to resident in care. This allegation is substantiated. Based on LPA interviews and items letters received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D. Report is reviewed with Noemi Velasquez and a copy of this report is provided on this day. Substantiatedthe state’s words, verbatim · CDSS document, Dec 10, 2024 · control 26-AS-20230818160901

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: Dec 11, 2024

87468.1 Personal Rights of Residents in All Facilities - (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This regulation has not been met as evidenced by: Based on the interviews conducted, it was found that S1 has yelled at R1 regarding non-payment of fees. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 10, 2024

Plan of correction: The facility shall develop a plan in writing addressing how the facility will address and plan accordingly to abide by this regulation at all times. This plan shall be received by the due date specified.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced case management - deficiencies visit and to amend the annual required inspection that was conducted on July 31, 2024. LPA met with licensee/administrator (LIC/ADM) TingXiu Li and stated the purpose of the visit. LPAs toured the facility inside and out including 4 resident bedrooms, two restrooms, kitchen, living room, dinning room, and backyard. LPA observed 3 of 3 residents were in their bedroom resting. LPA observed no toxic, chemicals or knives during today's visit that are accessible to residents. The screen door in the sun room was repaired and working properly. LPA toured the kitchen and pantry closet to observed 2 days of perishable foods and 7 days of nonperishable foods. LPA observed no obstructions on the walkways and hallways, exits were free from obstruction. Alcoholic beverages were in a locked container and all medications are in a locked cabinet. LPA reviewed the Centrally Stored Medication and Destruction Record (CSMDR) and observed that list of medication are listed on the CSMDR. LPA reviewed the appraisal needs and services plan (LIC 625) of 2 of 2 residents and observed that it was completed by LIC/ADM. LPA amended a repeat violation that was assessed incorrectly on 7/31/2024. No deficiency was cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with LIC/ADM TingXiu Li. A copy of today's report, amended citation and appeal's right was provided to the licensee.the state’s words, verbatim · CDSS document, Aug 16, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Aug 17, 2024

(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. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. LPA's observed chemicals ascessible to residents in care in the kitchen, bathroom, Sun Room and backyard. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 16, 2024

Plan of correction: ADM stated she will send LPA a written plan of action on how she will ensure Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger, are inacessible to residents in care. ADM stated she will send the Plan of correction by POC date 8/17/24.

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Simi Rai and Steve Chang arrived to the facility unannounced to conduct a case management visit to follow up on resident (R1) who was admitted after the previous facility was closed due to TSO (Temporary Suspension Order). LPAs met with staff (S1) Noemi Velasquez. LPAs spoke with Licensee/Administrator (ADM) Tingiu Li over the phone and stated the purpose of today's visit. LPAs obtained verbal permission from ADM for S1 to sign today's report on ADM's behalf. LPAs toured R1's room and observed bed with available bedding, a night stand and functioning lights. LPAs observed a bathroom which had a working toilet, sink and functioning lights. LPAs toured the kitchen and pantry closet to observed 2 days of perishable foods and 7 days of nonperishable foods. The facility staff is working with R1's responsible party and R1's physicians to obtain the necessary required documents for R1's file. The facility staff is continuing to monitor and assess the resident to ensure the appropriate care and supervision is provided to R1. During visit, LPAs observed a bar cart in front of the staff rooms which is located at the entrance of the sun room. The bar cart had over 6 bottles of alcohol which was accessible to residents. Based on review of resident's Physician's Report, resident is diagnosed with dementia. Staff S1 removed the alcohol bottles from the bar cart and placed them in the locked staff room. LPAs spoke with Licensee/Administrator (ADM) Tingiu Li in regards to Title 22 regulations and ADM stated she will ensure the bottles of alcohol are inaccessible to the residents with dementia. ADM agreed and understood. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. LPA Rai spoke with ADM over the phone and conducted an exit interview. This report was reviewed with Staff (S1) Noemi Velasquez and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Aug 8, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Aug 9, 2024

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances... This requirement is not met as evidenced by: Based on record review and observation, LPAs observed a bar cart infront of staff which had over 6 bottles filled with alcohol and are accessible to residents with dementia which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 8, 2024

Plan of correction: Licensee/Administrator stated to submit a written plan of action understanding regulation and will ensure alcohol is inaccessble to residents by POC due date. Licensee/Administrator agreed and understood.

Type of visit: Required - 1 Year

On 7/31/2024 at 9:35 a.m. Licensing Program Analysts (LPA) Maria (Mita) Partoza and Manuel Monter arrived and conducted an unannounced required 1 year inspection visit. LPA was greeted by the staff (S1). Licensee/Administrator Tingxiu Li, was not in the facility but arrived at the facility within 10 minutes. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over 6 non-ambulatory, and a waiver for 2 hospice care. The facility's has 2 residents (R1 to R2) that have neurocognitive impairment. 1 staff were present at the time of the visit. 2 residents were present at the facility and 1 of 2 was in the living room area. LPA observed 1 of 2 residents is in the bedroom and 2 of 2 residents are under hospice care. At 9:40 a.m. LPA toured the facility inside and outside with ADM, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, staff room, backyard and walkways. LPA observed the Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) on the cork board by the entry way printed on a 8 1/2 x 11 paper it is visible to visitors, resident and staff. The temperature inside the home was at 74 degrees F. LPAs and ADM toured the 4 bedrooms and LPA observed the rooms to be organized and free from debris and has sufficient storage for resident's personal belongings. 1 of the 4 bedroom is shared. The bathroom inside the shared room is used by other residents. Resident's bedroom has a call alarm system to alert staff if assistance is needed. Page 1 of 3 see LIC 809C During inspection LPAs took photographs what was observed in the kitchen, backyard, foyer, hallway, lounge and bathrooms regarding, chemicals, surveillance camera. LPAs tested the fire alarm/smoke detector and carbon monoxide and were observed to be in good working condition. The fire extinguisher was last inspected on 6/27/2024. LPAs requested to review the facility record for the disaster drill training, however ADM stated that he/she does not document the training and did not keep a training log. LPAs reviewed the personnel record and observed that the personnel training was conducted in time. LPA reviewed 2 of 2 resident centrally stored medication records while cross referencing the medication bottles, resident (R1) had 11 medications that were not listed in the centrally stored medication and destruction record (CSMDR) log. R1 had 1 medication bottle without a label. ADM stated that medication without a label was given by the family. Photograph were taken. Resident (R2) had 9 medication bottles that were not listed in the CSMDR. ADM stated that 7 of 9 medications are no longer prescribed by R2s PCP (primary care physician) and will be removed/destroyed. LPA requested to review R1 and R2's PRN (as needed) log. ADM stated she does not have a PRN log. ADM stated he/she was not aware that he/she had to have a PRN log. LPA reviewed facility records for 2 staff and 2 residents. LPA reviewed 2 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff and 1 residents. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. A civil penalty is being assessed for the amount of $250 for a repeat violation. This report was reviewed with Administrator Tingxiu Li and a copy of the signed report was provided. Page 3 Out of 3. END OF REPORT.the state’s words, verbatim · CDSS document, Jul 31, 2024

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Manuel Monter arrived to the facility unannounced to conduct a case management visit. LPA met with Administrator (ADM) Armando Guba. LPA explained the purpose of the visit. LPA interviewed S2. S2 stated ADM started working at the facility on January 15,2024. LPA interviewed ADM. ADM stated he started working at the facility on January 15, 2024. ADM stated the licensee would be out on leave for two weeks. ADM stated he has been informed of the care the residents need from the licensee. ADM stated he is also read up on their plan of care. ADM stated the licensee left on January 15, 2023, at night. ADM stated he is also an administrator for the facility, Mary's House 2. ADM stated the licensee still handles the finances. ADM stated if he goes shopping, the licensee will Zelle the cost of the items to the ADM. ADM stated he went grocery shopping recently for vegetables on January 16, 2024. ADM stated he will send LPA LIC500 for Rose Garden Elderly Care LLC and Mary house 2. No deficiencies cited during today's visit. This report was reviewed with Administrator Armando Guba and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Jan 17, 2024