Safe Haven Rose Garden

Type of visit: Required - 1 Year

On 05/13/2026 at 11:15am, Licensing Program Analyst LPA L. Hall conducted an unannounced annual required inspection. LPA met with Caregiver, Mary Grace Abaniel, Caregiver. House Manager, Bryan Bautista, arrived at 11:30am, and explained the reason for the visit. The administrator currently holds a certificate (#7031852740) that expires on 09/25/2027. The facility’s fire clearance was approved for six (6) Non-ambulatory residents. Hospice waiver for six (6). LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of seven (7) bedrooms and three and one-half (3-1/2) bathrooms. One (1) bedroom is occupied by staff. No bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 71 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 120.2 degrees Fahrenheit. Night lights are maintained in hallways and passages. Residents’ bathrooms are equipped with Continued on LIC809C. Continued from LIC809C. grab bars and non-slip mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 01/06/2026. Emergency Disaster Plan was last reviewed on 04/11/2025. Fire drill was last conducted on 05/07/2026. First aid kit was observed to be complete. The following forms to be updated and submitted to CCLD by 05/20/2026: LIC610E Emergency Disaster Plan (last page) Liability Insurance LIC308 Designation of facility responsibility LIC500 Personnel record A copy of the administrator certificate. LPAs observed the following deficiencies: At 11:20am, LPA observed pills sitting in a cup on top of the microwave in the kitchen. At 11:50am, LPA observed during record review no hospice care plan for R6. At 12:00pm, LPA observed S5 has not been fingerprinted and have been working and on the schedule since 5/3/2026. Continued on LIC809C. Continued from LIC809C. At 12:05pm, LPA observed S4 and S5, did not have a file available for review. At 12:20pm, LPA observed CCLD did not received a hospice initiation for R6. At 12:40pm, LPA observed a lock on outside of bedroom #3 (Staff stated it is used at night. At 12:44pm, LPA observed R4 had a full bedrail. At 12:57pm, LPA observed a lock on the outside of bedroom #5 (Staff stated it is used at night) At 12:50pm, LPA observed closet in bedroom #5 is used for a storage for facility items. *An immediate civil penalty for $500.00 will be assessed on today's date for fingerprints* Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights, LIC421BG, and this report provided.the state’s words, verbatim · CDSS document, May 13, 2026

Type of visit: Prelicensing

On 05/08/2025 at 9:55AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection. This is a continuance from the previous visit conducted on 04/15/2025. LPA met with Licensee, Kevin Parker and Administrator, Richard Grimesey and explained the purpose of the visit. On 04/15/2025 LPA toured facility including but not limited to resident's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPA observed lighting in all rooms. LPA observed facility had some non-perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Carbon monoxide detector was observed in operating condition. First aid kit was complete. Emergency disaster plan was complete. On 05/08/2025 LPA toured the facility and observed Licensee/Administrator made corrections from previous visit on 04/15/2025. Continue on LIC809C Continued from LIC809 LPA Conducted COMP III on 05/08/2025. The licensee/administrator was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first resident. This notification may be done by phone, by mail, email, or by fax. No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 8, 2025

Type of visit: Case Management - Other

On 05/08/2025 at 10:25AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived to conduct an announced Case Management COMP III visit. LPA met with Licensee, Kevin Parker/Administrator, Richard Grimesey and explained the purpose of the visit. LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participants gained knowledge about running and maintaining the facility in accordance with regulations. A license has not yet been granted to this facility. Licensure is subject to final review and approval by the Centralized Applications Unit. Licensee is not to accept consumers until notified by Community Care Licensing that the license has been approved. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 8, 2025

Type of visit: Prelicensing

On 04/15/2025 at 10:00 AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a Pre-licensing Inspection. LPA met with Licensee, Kevin Parker and Administrator, Richard Grimesey. LPA toured facility including but not limited to resident's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPA observed lighting in all rooms. LPA observed facility had some non-perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Carbon monoxide detector was observed in operating condition. First aid kit was complete. Emergency disaster plan was complete. The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB): 1. Hot water was measured at 128.8 degrees F in the common bathroom sink. Licensee lowered hot water and re-measured hot water at 125.1 degrees F. Continue on LIC809C Continued from LIC809 2. LPA observed facility does not have a grab bar near toilet in one of the common restrooms. 3. LPA observed facility does not have mattress pads for all resident beds. 4. LPA observed facility has furniture in the garage obstructing passageway 5. LPA observed facility does not have a covered area in backyard for residents in care. 6. LPA observed facility does not have an exit signs in the backyard identifying emergency exit . 7. LPA observed facility does not have a properly locked medicine cabinet. 8. LPA reviewed dementia plan and observed the plan does not address behaviors such as ingestion of toxic chemicals and wandering behaviors. Licensee/Applicant will submit proof of corrections to CCLD on/before 04/29/2025. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 15, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: RICHARD GRIMESEY, KEVIN PARKER Interview Method: Telephone interview On March 17, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 17, 2025