Rose Garden Villa II

Type of visit: Annual/Random

On 08/28/2025, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator, Jun Figueroa. The purpose of the visit was explained, and the LPA was allowed entry to the facility. This facility is licensed to serve 6 non-ambulatory adults ages 60 and above. The facility has an approved hospice waiver for 4 residents. Facility Layout: The facility is a single-story structure located in a residential neighborhood and consists of the following: (4) resident bedrooms, (2) resident bathrooms, living room, dining room, family room, kitchen, office area, a laundry area, de- attached garage used for storage, and backyard with table and chairs. Outside Grounds: were toured no bodies of water were observed, walkways around the home were clear of hazards, and there are no security bars or weapons on the premises. Kitchen Area/Facility Food: The facility has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept inaccessible to residents in care. There is fire extinguisher in the kitchen area and it was last serviced on 05/21/2026. There is a landline telephone on the kitchen counter top. Living Room/Community Indoor Space: There are sofa chairs, a large television and a fire place with a metal screen. Dining Room: There are games and work activities for residents and there is a landline telephone. Resident Bedrooms: 4 resident bedrooms were toured. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Bathrooms: Toilets, showers, and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries are accessible to residents. The hot water temperature measured 107 to 109 degrees Fahrenheit. Medications: were inaccessible to residents in care. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. 5 Medication Administration Records (MARs) were reviewed and they were current and up to date. Miscellaneous: Documents are posted as mandated. Last fire drill was conducted on 06/12/2026. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. The facility has a Disaster and Emergency booklet. The liability insurance is current. 5 staff records were reviewed, 5 out of 5 staff records had required documentation. 5 resident records were reviewed, 4 out of 5 resident records had required documentation. 1 out of 5 resident records did not have a tuberculosis test. 5 out of 5 residents Admission Agreements did not match department approved Admission Agreements. Technical advisories are being provided regarding trainings for Hoyer lifts and volunteers. Technical violations are being provided regarding: a videoconferencing device (e.g. smartphone); glucose testing; quarterly emergency disaster drills; Admission Agreements; and doctors orders for postural supports (e.g. medical beds with half bedrails & Hoyer lifts).. A deficiency is being cited based on observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding tuberculosis testing. An exit interview was conducted, Plans of Corrections were reviewed and developed, a copy of this report and appeal rights were discussed and left with the Administrator.the state’s words, verbatim · CDSS document, Aug 28, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a)(c)(1)(A) · Plan of correction due date: Sep 8, 2026

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by: Based on record reviews, the licensee did not comply with the section cited above in not having a tuberculosis test for Resident 5 which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 28, 2026

Plan of correction: The Administrator has agreed to email the tuberculosis test results for Resident 5 to Socorro.Leandro@dss.ca.gov

Type of visit: Case Management - Annual Continuation

On July 14, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced Case Management annual continuation using the CARE Inspection Tool to complete inspection conducted on 7/10/25. LPA was met by Jun Fausto Figueroa, Administrator and the purpose of today's visit was explained. The facility is licensed to operate for 6 elderly adults ages 60 and above (4 non-ambulatory and 2 ambulatory). There is an approved hospice waiver for (4). Current facility census is 4 (3 non-ambulatory and 1 ambulatory). Facility fees are current. Physical Plant/Structure: The facility is a single-story structure located in a residential neighborhood and consists of the following: (4) resident bedrooms, (2) resident bathrooms, living room, dining room, family room, kitchen, office area, a laundry area, de- attached garage used for storage, and backyard with table and chairs. File Review: LPA reviewed 4 resident files and found that ( 4 ) out of ( 4 ) had the required documents. LPA reviewed 4 staff files and found that ( 4 ) out ( 4 ) had the required documents, training, and certifications. Page 1 of 2 Medications LPA observed all centrally stored medications secured All medications were observed in their original packaging. LPA review 2 residents medication and MAR and found no discrepancies. Infection Control LPA observed required infection control signs posted throughout the facility. LPA observed a sanitizing stations in entryway of facility. LPA observed an ample supply of PPE supplies. Facility maintains General Liability Insurance which expires 9/20/2025.the state’s words, verbatim · CDSS document, Jul 14, 2025

Type of visit: Required - 1 Year

On July 10, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA was met by Jun Fausto Figueroa, Administrator and the purpose of today's visit was explained. The facility is licensed to operate for 6 elderly adults ages 60 and above (4 non-ambulatory and 2 ambulatory). There is an approved hospice waiver for (4). Current facility census is 4 (3 non-ambulatory and 1 ambulatory). Facility fees are current. Physical Plant/Structure: The facility is a single-story structure located in a residential neighborhood and consists of the following: (4) resident bedrooms, (2) resident bathrooms, living room, dining room, family room, kitchen, office area, a laundry area, de- attached garage used for storage, and backyard with table and chairs. Bedrooms: LPA inspected all 4 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Page 1 of 2 Bathrooms: Toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature, and it measured 105.7 degrees Fahrenheit. Common Rooms: All common areas are clean and free of obstructions. There is adequate seating for the residents in care. Each common area is equipped with furniture that is in good repair. Required Postings: LPA observed all required documents posted throughout the facility. The facility has a working landline telephone. Kitchen LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Sharps were locked away and inaccessible to the residents. Safety LPA observed 1 fully charged fire extinguishers last serviced on 6/25/2025. The last emergency drill was conducted on 4/18/25. First aid kid had all required items. Due to time restraint, LPA to continue inspection on subsequent visit. There were no citations issued during this visit. Exit interview conducted with Jun Fausto Figueroa, Administrator and copy of report provided. Page 2 of 2the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Required - 1 Year

On 07/17/24, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Jun Figueroa as the purpose of the visit was explained. The facility is licensed to serve (6) non-ambulatory residents ages 60 and above, there is an approved hospice waiver for (4). Current facility census is (4), facility fees are current. Liability insurance is active with an expiration date of 09/16/24. The facility is a single-story structure located in a residential neighborhood and consists of the following; (4) resident bedrooms, (2) resident bathrooms, living room, dining room, family room, kitchen, office area, a laundry area, de- attached garage used for storage, and backyard with table and chairs. Resident bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, showers was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to residents, no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards. LPA conducted a records review of 2 staff records, 2 resident records, and 2 medication administration records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 05/30/24, there is (1) fire extinguisher fully charged and located in the kitchen, carbon monoxide and smoke detectors were observed and are operational. Exit interview conducted with Administrator Jun Figueroa, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 17, 2024