Rose Cottage RCFE

Type of visit: Required - 1 Year

On 02/25/2026 at 3:00 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregivers, Apollo and Anthony McKarson and explained the purpose of the visit. Apollo phoned the Administrator, Lisa Bermudez and Licensee, Mynette Boykin, to inform. Ms. Bermudez and Ms. Boykin arrived to the facility shortly. The facility’s fire clearance was approved for six (6) residents in which all may be non-ambulatory. In addition, one (1) bedridden and an approved hospice waiver for two (2) residents. Administrator Certificate #6071393740 expires 07/29/2026. LPA toured facility with Apollo including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of seven (7) total bedrooms which six (6) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 106 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... LIC809-C (Page 2) Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 02/2026. Emergency Disaster Plan was last posted on 02/24/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/02/2025. LPA reviewed three (3) residents records. LPA reviewed seven (7) staff records and five (5) of seven (7) have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/04/2026: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 309 Administrative Organization - Reviewed Updated LIC 500 Personnel Report - Reviewed LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 25, 2026

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: POC

On 04/23/2025 at 10:25 AM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Plan of Correction (POC) visit and met with Caregiver, Apollo McKarson. LPA explained the purpose of the visit to Apollo. Apollo phoned the Licensee, Mynette Boykin to inform. LPA spoke with Licensee to explain the purpose of the visit. Licensee, stated that Administrator was not available but they would arrive to meet at the facility. Mynette arrived shortly. LPA conducted an Annual Inspection visit on 03/19/2025. The POC due date for cited deficiencies were 04/08/2025. The Licensee requested and extension to the due date which was granted to 04/18/2025. LPA did not receive the POCs on due date. Licensee shared emails between them, the resident's authorized representative and primary care physician. LPA granted another extension to May 7th, 2025 for all POCs with documents to be submitted to CCLD. Facility has the following deficiency that was not cleared: 87463(a) 87623(b)(2) 87628(a) No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 23, 2025

Type of visit: Required - 1 Year

On 03/19/2025 at 11:15 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Apollo McKarson and explained the purpose of the visit. Apollo phoned Administrator, Lisa Bermudez, to inform. Administrator arrived at the facility approx. 1 hour later. The facility’s fire clearance was approved for capacity six (6) all non-ambulatory of which one (1) may be bedridden. Hospice waiver approved for two (2) hospice residents. Administrator certificate # 6071393740 Expires 07/29/2026. LPA toured facility with Lisa and Apollo including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of seven (7) total bedrooms which six (6) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... LIC809-C (Page 2) Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/02/2025. Emergency Disaster Plan was last posted on 03/19/2024 First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/30/2025. LPA reviewed five (5) residents records. LPA reviewed five (5) staff records and three (3) of five (5) have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/26/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate - Reviewed The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 19, 2025

Type of visit: Case Management - Incident

On 11/07/2024 at 10:30am Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding an incident that was reported to Community Care Licensing Division (CCLD) on 07/30/2024. LPA met with Caregiver, Apollo McKarson and explained the purpose of the visit. Apollo called Licensee, Mynette Boykin and Administrator, Lisa Bermudez to inform. On 07/30/2024, CCLD received a Death Report from Administrator indicating that R1 passed away on 07/27/24. The death report did not state whether R1 was on hospice at the time of their passing. The death report indicated that R1 had a stroke in 2014, was paralyzed, kidney failure and high blood pressure. The death report further indicated that S1 went to check on R1 and found them not breathing and they called 911 and the family. LPA interviewed S1 that stated R1 was declining and that they called the family to inform but the family did not want to send their mother to the hospital. S1 stated that they tried to advise the family that R1's health was declining and that they should place R1 on hospice but the family refused. S1 further stated that they called 911 and told 911 emergency that the resident was declining but the family did not want R1 to go to the hospital. S1 stated that the 911 call representative stated to them if the family refuses to send R1 to the hospital that the family is the one responsible. S1 stated that R1 passed away the following day. LIC809-C (Next Page) LIC809-C Continued (Page 2) LPA interviewed S2 over the phone and S2 stated that R1 had a stroke 10 years ago and just started rapidly declining. S2 stated that the family was putting R1 on hospice at the end. LPA requested copies of R1's physician's report, appraisal needs and services, MAR, doctors orders, care notes, copy of police report and a copy of death certificate. LPA spoke with S2 over the phone and S2 stated that they have R1's records at the office and that they can have the documents tomorrow. LPA advised S2 to fax/e-mail the documents to LPA later today, 11/07/24. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 7, 2024

Type of visit: Required - 1 Year

On 03/19/2024 at 3:00 PM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Apollo McKarson and explained the purpose of the visit. Apollo phoned Acting Administrator, Lisa Bermudez to inform. Lisa arrived shortly after. The facility’s fire clearance was approved for 6 (Six) residents in which 1 (One) may be Bedridden. Hospice waiver approved for 2 (Two) residents. New Administrator Certificate pending. LPA toured facility with Lisa and Apollo including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 106.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 03/05/2024. Emergency Disaster Plan was last posted on . First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/19/2024. LIC809-C LIC809-C Continued... LPA reviewed 5 residents records. LPA reviewed 7 staff records and 4 of 7 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/26/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 19, 2024