331800063-3-22-2022-56-AS-EMAN-CDLT4T-20220418142429

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800063
Report Date: 03/22/2022
Date Signed: 03/22/2022 12:23:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2022 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220316125053

FACILITY NAME:	GARDENS OF RIVERSIDE, THE		FACILITY NUMBER:	331800063
ADMINISTRATOR:	STEPHANIE ODEN		FACILITY TYPE:	740
ADDRESS:	10849 ARLINGTON AVE		TELEPHONE:	(951) 637-8844
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92505
CAPACITY:	98	CENSUS: 84	DATE:	03/22/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Stephanie Oden		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff was physically aggressive with residents
Staff did not ensure resident was fed
Resident is not provided proper clothing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility in order to initiate a complaint investigation into the above allegations. LPA Williams identified herself to Administrator, Stephanie Oden, who was also informed of the purpose of the visit. The investigation consisted of direct observations, records review, and interviews with staff and residents.

In regards to allegation #1, LPA Williams interviewed Resident #1 (R1) and Resident #2 (R2) who both denied that staff were physically aggressive with them or other residents. R1 stated that facility staff are "excellent"
and denies that any staff member has been rough with R1. LPA Williams interviewed Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3) who all denied having knowledge of staff members being physically aggressive to residents. S1 did state that a former staff member did report to S1 that they witnessed Staff #2 (S4) pushing down on R1's shoulders as to sit R1 down in their wheelchair. S1 stated that S2 was interviewed, and S2 stated that they were redirecting R1 back into their wheelchair because R1 is a fall risk. S1 and S2 denied that
R2 was being handled in a rough manner or redirected with force.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 201-0159
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20220316125053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: GARDENS OF RIVERSIDE, THE	FACILITY NUMBER: 331800063
	VISIT DATE: 03/22/2022

NARRATIVE

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In regards to allegation #2, LPA Williams interviewed S1, S2, and S3. who all stated that R2, as well as all other residents, are provided with three meals and snacks a day.S1 and S2 both stated that R2 eats their meals and the facility has had no concerns with R2 eating meals. S3 stated that R2 does eat their meals; however, R2 will sometimes refuse to eat. LPA Williams interviewed R1 and R2 who both denied that facility staff are not ensuring the residents are fed. R1 and R2 both stated that they enjoy eating the facility's meals. At the time of visit, LPA Williams observed that lunch was being served to all residents in the facility's dining room.

In regards to allegation #3, LPA Williams interviewed S1 and S2 who stated that all residents are groomed and changed on a daily basis. S2 stated that there are some occasions where R2 is combative and refuses to change clothes, so they are only able to put on R2's shirt and depends. S2 stated that staff are able to put R2 in proper clothing when behaviors digress. LPA Williams interviewed R1 and R2 who denied that staff are not providing proper clothing to the residents. At the time of visit, LPA Williams observed that all residents are dressed appropriately and appeared to be well-groomed.

Based on evidence obtained during today’s visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed and a copy was provided to Oden at the conclusion of the investigation.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 201-0159
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

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