331800063-5-9-2023-56-AS-EMAN-CS5V4H-20230524160619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800063
Report Date: 05/09/2023
Date Signed: 05/09/2023 12:26:31 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
04/11/2023 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230411161018

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: 89	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Resident Care Director Jessica Padron		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Staff hit resident.

INVESTIGATION FINDINGS:

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On 05/09/2023, Licensing Program Analysts (LPAs) Melody Brown and Mary Rico made an unannounced visit to the facility to deliver the findings of the above allegation. LPAs Brown and Rico explained the purpose of the visit. Staff contacted Resident Care Director Jessica Padron to assist LPAs Brown and Rico. The investigation consisted of file review, interviews with staff and residents as well as observation.

The investigation was conducted by LPA Brown. The investigation consisted of file review and interviews with relevant parties. The allegation indicates Staff hit resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with staffs and residents indicated that staffs do not hit residents and there’s no incident happened at the facility that a staff hit a resident.

**** Continuation on LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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-20230411161018

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: 05/09/2023

NARRATIVE

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During the facility visit last 04/13/2023, LPA Brown observed that four (4) staffs work at Magnolia Building and three (3) staffs were assigned to Jasmin Building and two (2) Medical Technician (MedTechs) for both buildings. Moreover, during the facility visit last 05/09/2023, Resident Care Director Jessica Padron reported to LPAs Brown and Rico that they completed their own investigation and concluded that no staff at the facility hits a resident in care and no incident happened at the facility that a staff hits a resident.

Based on interviews and records review, the allegation Staff hit resident is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, where this report (LIC9099) was discussed and provided to Resident Care Director Jessica Padron.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

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