Fullerton Rosewood Assisted Living

Allegation investigated: Resident's personal rights were violated

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings regarding the above-mentioned allegation. Upon arrival, LPA Haddadin was met by Office Assistant Jin Pak, who granted entry into the facility. LPA explained the purpose of the visit. Administrator Jane Kim was notified via phone and advised of the visit.. The Department received a complaint alleging that “Resident’s personal rights were violated.” During the investigation, LPA conducted interviews with Resident 1 (R1), facility staff, residents, and the responsible party. LPA also reviewed R1’s file and facility records, including the Release of Client/Resident Medical Information form, Consent for Emergency Medical Treatment, Adult and Elderly Residential Facilities form signed by the responsible party, Physician’s Report, Resident Appraisal, and Admission Agreement. {***CONTINUE 9099C***} Unsubstantiated Interviews with staff revealed that four of four staff interviewed stated they have not witnessed facility staff sharing residents’ personal or confidential information without authorization. Staff stated that they contact physicians or responsible parties when additional medical information is needed for resident care, including updated medication lists, clarification of physician’s orders, discharge paperwork, and changes in condition. Staff further stated they have not released confidential information regarding residents or resident records to unauthorized persons. During an interview with R1, R1 stated that staff contacted R1’s physician without R1’s consent or knowledge. Interviews with residents revealed that four of four residents interviewed stated they have not experienced facility staff sharing confidential resident information without their consent. Records reviewed revealed that R1’s Admission Agreement was signed and reviewed with the responsible party. The responsible party initialed the section acknowledging receipt of Resident Rights, which includes the resident’s or responsible party’s right to make decisions regarding medical treatment and advance health care directives. Record review further revealed that the responsible party signed the Consent for Emergency Medical Treatment form, which authorized Fullerton Rosewood Assisted Living to obtain emergency medical or dental care prescribed by a licensed physician for R1. The consent stated that such care may be provided under whatever conditions are necessary to preserve the well-being of the individual named. LPA also interviewed the responsible party, who confirmed being R1’s responsible party, confirmed signing the forms, and stated they had no concerns regarding the facility. During the investigation, LPA observed that resident records were maintained in a secure location and were not accessible to the public. Based on interviews and record review, the Department has investigated the allegation that “Resident’s personal rights were violated.” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated. An exit interview was conducted with Office Assistant Jin Pak, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 2, 2026 · control 22-AS-20260306135751

Allegation investigated: Staff did not address an ongoing conflict between residents Staff did not treat resident with dignity or respect

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff and residents as well as reviewed and obtained pertinent documentation such as eviction notice. Regarding the allegations that staff did not address an ongoing conflict between residents and staff did not treat resident with dignity or respect, the investigation revealed the following: Incident dated 01/27/2026 reported to licensing indicated that Resident 1 (R1) threatened R2 verbally and raised the resident's walker at R2. 911 was called by R2's family member as R1 was escalating. There were no injuries between the two residents and police talked to both parties involved. Administrator indicates a long history of issues between the two residents instigated by R1. R1 denies threatening R2 with a walker or yelling at the resident. R2 confirms the incident occurred. R1 was provided an eviction notice on 07/17/2025 for similar instances with other residents. R1 has yet to move out and CONTINUED ON LIC 9099C DATED 02/25/2026 Unsubstantiated Administrator will be moving towards an unlawful retainer. Facility notes dated 01/28/2026 show R2 is being provided escorting due to harassment concerns by R1. R1 states she is treated with respect in the facility but wants to be listened to regarding ongoing issues with R2. Administrator indicates having continuing conversations with R1 regarding harassment of other residents. Based on interviews conducted and records reviewed, the department is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Feb 25, 2026 · control 22-AS-20260217201628

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by the Office Assistant at 8am. During today’s visit, LPA met with Administrator (AD), Jane Kim.. The facility is a two story building with an approved fire clearance of ninety-nine non-ambulatory, and a hospice waiver for five residents. The facility currently has a census of fifty-two residents in care and none of the residents receive hospice services. The facility does not have a Memory Care. Documents were obtained for the most recent fire inspection, which was conducted by the Fullerton Fire Department, on January 7, 2026. All smoke detectors were operational. The carbon monoxide detectors were tested on December 15, 2025 and are operational. The fire extinguishers were charged and were serviced on December 10, 2025. The facility’s last fire drill was conducted on January 7, 2026. LPA observed an evacuation chair in the two internal stairwells and another evacuation chair for the outside emergency exit stairwell. There are two elevators in the building and both were in working order. LPA reviewed the Emergency Disaster Plan and Infection Control Plans and both were current. During today’s visit, LPA toured the facility and noted the interior temperature was seventy five degrees. The PUB 475 See Something, Say Something sign was posted along with the Resident Council notes and the Activities Calendar. Residents were observed eating lunch and socializing. After lunch, residents congregated in the dining room and LPA observed a Christian service with residents singing hymns. (Continued on LIC 809-C) (Continued from LIC 809) LPA inspected the kitchen and observed the fire extinguishers were charged. The walk-in refrigerator/freezer had ample perishable items and the pantry had more than seven days non-perishable food on hand. Modified diets were posted for culinary staff in the kitchen. Cleaning solutions and chemicals were secured, as well as sharps and knives. There were no pests or odors and the kitchen surfaces were clean after lunch. Emergency supplies were stored in a storage area on the second floor and the facility has four large water tanks. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit had the required elements and a Nurses Manual was available with First Aid instructions. The facility interior temperature was seventy five degrees. LPA inspected hot water temperatures in four of four resident bathrooms. The hot water temperatures measured between 105.1 to 113.1 degrees Fahrenheit. LPA observed resident apartments had the required furnishings and were clean. Bathrooms had grab bars and non-skid mats. All bedrooms have a call light button on the wall, as well as a pull cord in the bathroom. The signal system is relayed to the front desk, as well as to staff pagers, to answer calls. LPA toured the exterior of the facility, which is an enclosed courtyard. There were no obstructions on pathways and there was shaded seating areas for residents to sit outside to observe the various plants and greenery. There is a laundry room located on the first floor for residents to use and chemicals are secured. LPA reviewed four of four staff training and fingerprint records and five of five resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on November 26, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Jane Kim, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Feb 18, 2026

Allegation investigated: Staff did not keep resident's informaiton confidential.

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit on an investigation competed by the Department. LPA Tirre was greeted and granted entry by staff and explained reason for visit. LPA met with Administrator Jane Kim. During the course of investigation, the Department conducted interviews and reviewed documents. The investigation conducted revealed the following: On January 2, 2026 the department received a complaint alleging that staff did not keep residents’ information confidential. Department conducted interviews with staff, residents and witness. Interviews with staff revealed that five Five of five staff state that they have not witnessed other staff giving out personal information of residents. Three of five staff stated they contact either Physician or responsible parties if additional medical information is to be obtained on behalf of residents care such as updated medication lists, clarification of Doctors orders, discharge paperwork, change of condition or other medical related information. Five of five staff have stated they have not given out confidential information regarding continued on 9099C Unsubstantiated residents or residents files. Staff stated that information obtained is handled privately. Interview with Witness, revealed that they have not experienced any facility staff sharing confidential resident information without consent. Interview with Resident 1, stated that Staff1 had contacted Physician without consent or knowledge. Records reviewed revealed that Resident 1’s Admission Agreement was signed and reviewed with responsible party. Responsible party initialed acknowledging they received Resident Rights stating resident or responsible party have the right to make decisions about medical treatment and advanced health care directive. Record review revealed that Responsible party signed consent for “ emergency medical treatment stating they give Fullerton Rosewood Assisted Living consent to provide all emergency medical or dental care prescribed by licensed physician for Resident 1, stating this care may be given under whatever conditions are necessary to preserve the well being of the individual named". During investigation, LPA observed resident records are in a secure location and not accessible to public. Due to the information provided in investigation, the preponderance of evidence was not met. The allegation Staff did not keep resident's information confidential is deemed UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred as reported. An exit interview was conducted with Administrator Jane Kim and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 8, 2026 · control 22-AS-20260102163909

Allegation investigated: Staff yelled at a resident in care. Staff illegally evicted a resident in care.

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged staff yelled at resident in care and staff illegally evicted a resident in care. During the investigation, LPA conducted interviews with residents in care and staff. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation staff yelled at resident in care, it was reported Administrator (AD) Jane Kim was yelling and humiliating Resident 1 (R1). LPA interview with R1 stated AD yelled at them most recently on October 22, 2025 but cannot articulate the details of the incident or recall which staff or residents witnessed the incident. Interviews with five out of five remaining residents stated they have never been yelled at by staff and have not witnessed staff yell at other residents. Unfounded Interviews with three out of three staff stated they have never yelled at residents and have not witnessed any other staff yell at residents. Interview with the AD stated there was an incident a couple of years ago when R1 and R1’s family member were yelling at the AD and the AD had to speak over them to direct them to leave the office. Regarding the allegation staff illegally evicted a resident in care, it was reported R1 was evicted from the facility. LPA interview with R1 stated they have not been served with an eviction notice recently but the facility did attempt to serve an eviction notice in July 2025 in which R1 refused to accept. LPA interview with AD stated an eviction notice was served to R1 in July 2025 due to R1’s aggressive behaviors towards other residents and a copy was sent to the Department for review. AD stated they decided not to follow through with the eviction and no further eviction attempts have been made since. LPA record review revealed R1 was served with an eviction notice on July 17, 2025 with a copy sent to the Department, R1, R1’s family, and the ombudsman. LPA verified the required language was included in the eviction notice. Based on interviews and record review, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report was left with the facility representative.the state’s words, verbatim · CDSS document, Jan 2, 2026 · control 22-AS-20251224150848

Allegation investigated: Due to lack of supervision, resident physically assaulted another resident

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrived at the facility was greeted and granted entry by staff. LPA spoke with Jane Kim, Administrator, and explained the purpose of the visit. Findings are based upon this investigation which included tour of the physical plant of the facility, resident/facility file review, and interviews conducted. It is alleged due to lack of supervision resident physically assaulted another resident. Record review reflects that at the time of visit census was 54 residents and staff roster reflect there is three shifts AM, PM, and NOC with 2-4 carestaff assigned per shift. An unusual incident report LIC621 received on July 10, 2025, resident Continued on LIC9099-C Unsubstantiated (R1) and resident (R2) had an altercation with each other in the apartment/bedroom hallway on July 5, 2025. Records for R1 and R2 revealed that they are alert, do not require any ambulatory assistance, functional capabilities or physical services, do not require 1:1 ratio care, and do not require 24 hour care. Interviews with 2 of 2 staff stated that neither resident required 1:1 ratio care or 24 hour care and that incident happened in a common space of the facility and staff immediately intervened once they were notified of the incident. Since neither requires such care it is not uncommon for incidents to occur in common spaces of the facility or where staff is not around. Staff stated they immediately applied de-escalation methods and this was the first incident involving R1 and R2 and since incident they have not had any further incidents amongst R1 and R2. Staff stated that they have taken adequate measures to address the situation. Interviews with 6 of 6 residents stated that staff are good at assisting them when they need help and get help almost immediately. They have never had issues with not getting assistance and there is always staff around to help. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at the facility.the state’s words, verbatim · CDSS document, Jul 24, 2025 · control 22-AS-20250711095927

Allegation investigated: Staff did not maintain facility floors free of debris

On July 10, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the above listed allegation. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Jane Kim was notified via telephone and later arrived to assist with the inspection. The facility is a two story building with resident bedrooms located on the first floor and second floor. The facility also has additional common areas that include a lobby area, a dining room, a courtyard, and a lounge room. On today's visit, LPA collected pertinent documents such as current resident roster, the current staff roster, and resident records. LPA also conducted six resident interviews and five staff interviews. Additionally, LPA, accompanied by the AD, conducted a tour of the physical plant. LPA inspected six resident bedrooms, which include resident bedrooms on the first and second floor, and observed them to be clean and free of any debris. CONTINUED ON LIC9099-C Unsubstantiated LPA also inspected all common areas including the lobby, dining room, courtyard, and lounge room which were observed to be clean and free of any debris. LPA additionally inspected each resident hallway on both the first and second floor and observed them to be clean and free of debris. Resident hallways were free of any hazards and are maintained in good repair. Six out of six residents interviewed stated the facility is maintained in a clean manner and denied observing any debris on the facility floors. Five out of five staff interviewed also denied observing any debris on the facility floors. Based on the evidence gathered during the investigation, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator (AD) Jane Kim and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 22-AS-20250703160418

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Angelica Juarez and explained the reason for the visit. Administrator arrived shortly after. The facility is licensed to serve 99 non-ambulatory residents over the age of 60 with a hospice waiver for 5. The facility is located in a commercial residential area and consist of a two story building with a commercial kitchen, dining room, library area, TV area, offices, reception, a courtyard, residents rooms in the first floor. The second floor consist of a lounger area and residents bedrooms. Each resident bedroom has a private bathroom. LPA Flores toured the facility with Angelica Juarez and observed the following: Common areas are clean and in good repair. Library provides a variety of reading material. Kitchen is in good repair, clean, food was observed sufficient for at least 2 days of perishables and 7 days of non-perishables. List of special diets was posted in the kitchen. LPA observed a total of 6 resident bedrooms each has the required furniture and bedding supplies, with sufficient lighting. Bathrooms were observed in each room in working condition. Grab bars were missing around or inside the shower in room #109, 229, and 240. Per staff showers have been recently replaced. Water temperature was tested in the resident's bathrooms and tested between 104.7-118.2 degrees F., which is not within the required 105-120 degrees F. Room #129 water temperature tested at 104.7. Facility has a fire sprinkle system throughout. Fire extinguishers have been observed throughout which were last checked on 4/4/24. Courtyard was observed in good repair with shaded seating area. No large bodies of water were observed. Medication room, cleaning supplies, and sharps were inaccessible to the residents. Second floor has sunlight panels in the roof, the panel above the lounge room was observed broken with an opening of about 16in by 24in covered with cardboard. (CONT. LIC 812) Per administrator it was broken by solar panel installers that came in on 12/5/24 and a quote for repairs is being obtain. Laundry room was observed. Sufficient linens were observed. Cleaning supplies and PPE supplies were observed. Emergency food supplies were observed in a closet in the second floor. All passage ways are clear and free of obstructions. Required posters were observed in the common areas and visible to the residents. Evacuation chairs were observed on top of each staircase (3). LPA tested alert call button which is in working condition and caregiver responded within 5 minutes. LPA observed half bed rails in bedroom #129 and a physician's bed rail request was observed in residents file. LPA reviewed medication and files for 5 residents and 5 staff files. Staff received 20 hours of training for the current year. Administrator certificate was observed for Jane Kim #6022176740 exp. date: 11/29/24. Administrator submitted renewal documents to the department on 11/19/24. LPA interview 4 residents and 4 staff. Infection Control plan and Emergency Disaster plan were reviewed. Technical Violations have been noted today. No deficiencies were noted. Exit interview was conducted with Jane Kim and a copy of this report and technical violations were provided.the state’s words, verbatim · CDSS document, Dec 7, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Medication not being administered properly Facility not allowing visitors

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility, interviewed staff and residents as well as reviewed and obtained pertinent documentation such as medication training records. Regarding the allegation that medication not being administered properly and facility not allowing visitors, the investigation revealed the following: Facility protocol is to have caregivers/ med techs administering medications in the dining room before meals. Caregivers assist in the dining room with serving meals to residents. Residents may interact with the same caregiver who passed medications during their meal. LPA reviewed medication training records and all staff administering medications have proof of current medication training. Upon entry to the facility, LPA observed front door is locked with a bell and phone number to call for entry. LPA rang bell and was immediately greeted into the facility. Administrator indicates locking the front door for the last several weeks due to covid cases. CONTINUED ON LIC 9099C DATED 1/8/2024 Unfounded Administrator states door is locked so staff can advise all guests of covid status and to deter outside traffic from entering during active covid cases. The back door is open and unlocked which backs up to the parking lot. Administrator indicates most visitors utilize the back entrance. LPA observed visitors in the facility as well as staff answering the front door promptly. Eight out of eight residents and four out of four staff deny visitors are denied entrance into the facility. All residents interviewed indicated their family members visit frequently and have had no issues with visitation. Facility does not house residents with Dementia. Based on record review and interviews conducted, the allegations are deemed UNFOUNDED meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Jan 8, 2024 · control 22-AS-20240103132234