Rose Villa

Type of visit: Required - 1 Year

On 5/29/2026 at 08:40 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA Serrano met with Administrator Manzoor Massey and was granted entry to the facility. At the time of the visit there was one (1) staff present, and five (5) residents present. The facility is a five (5) bedrooms, three (3) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory and two (2) hospice waiver and 1 maybe bedridden resident and the current census is five (5) residents. LPA was accompanied by Staff #1 to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 70 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 116 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms.. Fire extinguisher were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws were posted in a common area. Facility does not have an updated infection control plan, disaster drill and emergency disaster plan onsite. Facility does not have non-lip mat in the bathrooms. Deficiencies issued. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPA observed complete first aid kit but needs an updated first aid book. Deficiency issued. LPA observed that the left side gate is broken. Deficiency issued. Food Service: Two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Facility does not have enough seven (7) day non-perishable food. Deficiency issued. LPA observed that the facility does not have 72 hour emergency food for the resident although the facility have plenty of emergency water in the premises. Deficiency issued. Care & Supervision: The facility has an Administrator present in the facility with enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and need and services plan. LPA observed resident files were missing the needs and services plan for resident #2(R2) and resident#3(R3). Deficiency issued. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed that staff#1 (S1) does not have an updated CPR certificate. Deficiency issued. Based on the observations made during today’s visit, Deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C and LIC809D and appeal rights were discussed and provided to Administrator Manzoor Massey.the state’s words, verbatim · CDSS document, May 29, 2026

Type of visit: Required - 1 Year

On 8/15/2025 at 09:40 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA Serrano met with Administrator Manzoor Massey and was granted entry to the facility. At the time of the visit there was two (2) staff present, and six (6) residents present. The facility is a five (5) bedrooms, three (3) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory and two (2) hospice waiver and 1 maybe bedridden resident and the current census is six (6) residents. LPA was accompanied by Staff #1 to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 degrees Fahrenheit. LPA Serrano inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 120 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms.. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** LPA observed that the garage side door handle is broken. Deficiency issued. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPA observed complete first aid kit and first aid book at the facility. Food Service: More than seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. LPA observed that the facility does not have 72 hour emergency food for the resident although the facility have plenty of emergency water in the premises. Deficiency issued. Care & Supervision: The facility has an Administrator present in the facility with enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and need and services plan. LPA observed resident files were missing the needs and services plan for resident #1(R1) and resident#2(R2). Deficiency issued. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings.LPA observed that staff#2 (S2) does not have the health screening report. Deficiency issued. Based on the observations made during today’s visit, Deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, LIC9102 and LIC809D and appeal rights were discussed and provided to Administrator Manzoor Massey.the state’s words, verbatim · CDSS document, Aug 15, 2025

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator Massey Manzoor, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (6), a current census of (6). LPA Ramirez conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has a swimming pool gated and locked inaccessible to residents in care. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility is equipped with operating smoke detectors/carbon monoxide alarms, laundry equipment, and telephone service. Resident’s showers, toilets, and hand washing areas were operating properly. The hot water temperature in residents bathrooms measured at 120 degrees F. Five (5) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, Ombudsman poster, facility license, Administrator certificate, emergency disaster plan, personal rights, menu, and emergency telephone numbers. Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were not kept locked and inaccessible to residents in care, deficiency will be issued. Continuation on LIC – 809C: Care & Supervision: Facility has 24-hour/7days a week care staff. Facility staff have current CPR/first aid training. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: Two (2) Staff files reviewed were observed to be incomplete, deficiency will be issued. Two (2) Resident files reviewed were observed to be complete. Based on observations and record review deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report with appeal right and LIC 809D was discussed and provided to Administrator Massey Manzoor.the state’s words, verbatim · CDSS document, Oct 14, 2024

Allegation investigated: Resident sustained a fracture while in care.

Licensing Program Analyst (LPA) Anna Fannell conducted a subsequent visit to the facility to deliver findings on the above allegation. LPA met with care provider Karina Chaveres who was informed of the reason for today's visit. Chavares notified Licensee Mazoor Massey of LPA's presence and Massey arrived shortly. LPA conducted the initial complaint visit and investigation included interview with relevant parties and review of records. It is alleged that Resident (R1) sustained a fracture while in care. On 1/2/2023, the Department received an incident report of R1 falling at the facility and being sent to a local hospital. The incident report further states that R1 sustained a broken leg and needed surgery. LPA reviewed American Medical Response (emergency services) records and records revealed that R1 leaned against a wall and gradually lowered themself to the ground while facility staff assisted R1 down. Review of LIC603A, Resident Appraisal, shows that R1 is able to walk without any assistance and R1 does not own any walking assistive devices. Physician’s report, LIC602, reviewed by LPA stated that R1 does not have motor impairment/paralysis and is ambulatory. Medical history noted that R1 is high risk for falls as of 01/02/2022. However, interview with Staff 1 (S1) revealed that R1 Unsubstantiated walks with a weak leg, appearing to drag their leg while ambulating. LPA Fannell review of hospital record shows that upon admission, R1 stated to attending physician that they were walking, tripped, and fell on their hip. Based on the above information, the allegation is therefore unsubstantiated. Based on the available information, we have found the complaint allegations to be UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Manzoor Massey at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 26, 2024 · control 56-AS-20230103155228

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Anna Fannell conducted an unannounced visit to this facility to deliver findings for complaint control number: 56-AS-20230103155228. LPA met with care provider Karina Chaveres who was informed of the reason for today's visit. Chavares notified Licensee Mazoor Massey of LPA's presence at the facility and Massey arrived shortly. The report was discussed with and copy was provided to Licensee at the conclusion of today’s visit.the state’s words, verbatim · CDSS document, Mar 26, 2024