331800063-3-30-2022-56-AS-EMAN-CDLS4T-20220418133316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800063
Report Date: 03/30/2022
Date Signed: 03/30/2022 02:40:10 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
03/24/2022 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220324130222

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: 83	DATE:	03/30/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Stephanie Oden		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident sustained unexplained injuries while in care.

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.

LPA Williams interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), and Staff #4 (S4), who all stated that Resident #1 (R1) has experienced several witnessed and unwitnessed falls at the facility causing several bruised and injuries to R1. All staff members interviewed stated that R1's condition has rapidly declined which has caused R1 to become a fall risk due to increased unsteady gait. All staff members interviewed also stated that R1 also displays aggressive and self-injurious behaviors; such as, slamming R1's arms on furniture, throwing furniture, crawling on the floor, and bumping into walls. S1, S2, S3, and S4 denied that physical abuse/aggression by the staff members are the cause for R1's injuries.

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: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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-20220324130222

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: 03/30/2022

NARRATIVE

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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 was discussed (LIC 9099) and a copy was provided to the Administrator at the conclusion of the visit.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 201-0159
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC9099 (FAS) - (06/04)

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