Rosehaven III Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Rosehaven III Care Home. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 5 residents. There are 2 residents on hospice during today's visit. LPA Lyman along with Administrator Shalaby toured the facility at 8:20 AM. LPA toured the physical plant, checked food service, reviewed records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of four resident bedrooms, two resident restrooms, common restroom, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed four residents with half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 109.2 and 114.9 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA observed cook top does not have protective mechanisms on at entry. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked and self latching. CONT ON LIC809-C DATED 03/18/2026 LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 02/25/2026. Facility provides activities in the form of exercise and music therapy. At 9:00 AM, LPA reviewed five resident files and four staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff file review indicated four out of four staff do not have all required training hours. Administrator Shalaby's administrator certificate expired on 05/21/2025. Review of pending applications shows the renewal application was submitted on 03/10/2026. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited bi-monthly by staff. Medications appear to be administered per physician order. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Mar 18, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 03/11/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. Administrator Tina Shalaby arrived during the visit. *Deficiency cited under Title 22 Regulation 87355(e)(3) pertaining to Criminal Record Clearance has been cleared. Licensee associated noted individuals. Licensee has complied with the terms of the POC. *Deficiency cited under Health and Safety Code 1569.695(c) pertaining to Emergency Drills has been cleared. Licensee provided proof of drill conducted on 03/20/2025. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87412(c) Pertaining to Personnel Records has NOT been cleared. Licensee has not conducted required annual training. Licensee has not complied with the POC. *Deficiency cited under Title 22 Regulation 87456(a)(3) Pertaining to Evaluation for Suitability of Admission has been cleared. Licensee obtained medical assessment. Licensee has complied with the POC. Licensee addressed items on the advisory notes issued on 03/11/2025. Based on the observations made during today's visit, the following violation IS being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Apr 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: May 1, 2025

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the section cited above. Licensee does not have all training requirements in the file. This poses a potential health and safety risk to residents in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Apr 17, 2025

Plan of correction: Licensee to conduct training and forward proof to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Rosehaven III Care Home. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 4 residents. There are no residents on hospice during today's visit and one resident receiving home health care service. Administrator Tina Shalaby has a current administrator certificate expiring on 05/21/2025. LPA Lyman along with Caregiver Annie Macaraeg toured the facility at 7:56 AM. Administrator Tina Shalaby arrived during the visit. LPA toured the physical plant, checked food service, reviewed records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of four resident bedrooms, two resident restrooms, common restroom, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with a half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 110.6 and 116.2 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 09/15/2024. Facility provides activities in the form of exercise and music therapy. CONT ON LIC809-C DATED 03/11/2025 At 9:00 AM, LPA reviewed four resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Resident 4 (R4) does not have a medical assessment in the file. Staff files did not contain proof of training. Two out of three staff do not have association to the facility. At 9:30 AM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly by staff. Medications are being administered per physician order. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Michael Tea and Kimberly Lyman conducted an unannounced visit to Rosehaven III Care Home. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs was allowed entry into the home and met with Administrator Tina Shalaby. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 5 residents. There are no residents on hospice during today's visit and one resident receiving home heatlh care service. LPAs Tea and Lyman along with Administrator Tina toured the facility at 8:45 AM. LPAs toured the physical plant, checked food service, and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of four resident bedrooms, two and half resident bathrooms, one staff room, one shared hall bathroom, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPAs observed three residents with a half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 108.6 and 110 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. The entry door into the garage is secured. LPAs observed a locked storage area for cleaning supplies under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPAs observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPAs toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked. LPAs observed ample emergency food and water supply. LPAs reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 03/05/2024. Facility provides activities in the form of exercise, physical therapy and bible studies. CONT ON LIC809-C DATED 04/18/2024. At 10:00 AM, LPAs reviewed five resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed contained required documentation of annual training, health screen/TB, and criminal record clearance. At 11:15 AM, LPAs reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly by staff. Medications are being administered per physician order. Based on the observations made during today's visit, no deficiencies are being cited. Exit interview conducted and a copy of this report was given at time of visit.the state’s words, verbatim · CDSS document, Apr 18, 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.