331800063-8-11-2023-56-AS-KCLS-CURL3H-20230816082357

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800063
Report Date: 08/11/2023
Date Signed: 08/11/2023 12:43:53 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
12/29/2022 and conducted by Evaluator Rayshaun Nickolas

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221229153126

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: 91	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Stephanie Oden, Executive Director		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Resident not getting assistance with eating.
Resident not receiving proper supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Executive Director Stephanie Oden and explained the purpose of the visit. The investigation included file review, facility tour, and interviews with relevant parties.

Allegation #1 “Resident not getting assistance with eating”. The allegation alleged that several facility staff members are not assisting or taking extra time to assist client #1 (C1) with eating. LPA Nickolas's interview with several facility staff members revealed that they are helping clients in care with eating. LPA Nickolas’ observations during the facility tour revealed that facility staff members assisted clients with eating. LPA Nickolas’ observed staff #1 (S1) assisting C1 with eating. C1 was unable to participate in the interview process. Finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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-20221229153126

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: 08/11/2023

NARRATIVE

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Allegation #2 “Resident not receiving proper supervision”. The allegation alleged that facility staff members are not providing adequate supervision of C1 resulting in falls. LPA Nickolas’ interview with several facility staff members revealed they are assigned clients to provide care and supervision, and can request additional assistance from other facility staff members if necessary. LPA Nickolas's observations during the facility tour revealed adequate staffing in all buildings to meet client’s needs. LPA Nickolas observed S1 providing care and supervision to C1. C1 was unable to participate in the interview process. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means 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 and copy of this report was provided.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

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