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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800063
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:58:57 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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2021 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211213163409
FACILITY NAME:GARDENS OF RIVERSIDE, THEFACILITY NUMBER:
331800063
ADMINISTRATOR:STEPHANIE ODENFACILITY TYPE:
740
ADDRESS:10849 ARLINGTON AVETELEPHONE:
(951) 637-8844
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:98CENSUS: 81DATE:
12/17/2021
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Joanna HandyTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Resident's care needs are not being met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Williams conducted an unannounced visit to the facility in order to initiate a complaint investigation into the above allegation. LPA Williams identified herself to Business Office Manager, Joanna Handy, who was also informed of the purpose of the visit. The investigation consisted of direct observations, records review, interviews.

LPA Williams interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3) who all denied that the residents care needs are not being met. S1, S2, and S3 stated that they are properly caring for all residents in care. LPA Williams interviewed Family Member #1 (FM1) and Family Member #2 (FM2) who both denied that the facility is neglecting to meet Resident #1's (R1's) care needs. FM1 and FM2 stated that R1 is being well taken cared of. LPA Williams interviewed Case Manager #1 (CM1) who stated that there were no indications of neglect or resident care needs not being met in the hospice agency's documentation. LPA Williams reviewed R1's hospice notes dated 11/2/2021, which indicated that R1 was experiencing a functional decline. LPA Williams observed R1, who appeared to be well-groomed, dressed in clean clothing, and interacting with several staff
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20211213163409
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
RIVERSIDE, CA 92507
FACILITY NAME: GARDENS OF RIVERSIDE, THE
FACILITY NUMBER: 331800063
VISIT DATE: 12/17/2021
NARRATIVE
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Based on evidence obtained during the investigation, LPA has determined that the above allegation is 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 was discussed and a copy was provided to at the conclusion of the investigation.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2