<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800063
Report Date: 05/08/2024
Date Signed: 05/09/2024 08:53:42 AM

Substantiated


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
12/04/2023 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231204083515
FACILITY NAME:GARDENS OF RIVERSIDE, THEFACILITY NUMBER:
331800063
ADMINISTRATOR:GRISELDA T. GARCIAFACILITY TYPE:
740
ADDRESS:10849 ARLINGTON AVETELEPHONE:
(951) 637-8844
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:98CENSUS: 86DATE:
05/08/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Executive Director Griselda Torres GarciaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident has access to a master key to open facility doors.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/08/2024 at 01:45 PM, Licensing Program Analysts (LPAs) Melody Brown and Sarina Ramirez met with Executive Director Griselda Torres Garcia at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegations. LPAs Brown and Ramirez explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation.

The investigation was conducted by LPA Melody Brown. The investigation consisted of file review and
interviews with relevant parties. The allegation indicates that Resident has access to a master key to open facility doors. LPA Brown obtained evidence to corroborate the allegation above. Interviews with two (2) of three (3) staffs indicated that Resident #2 (R2) has a key that was able to open other resident doors. Local Long Term Care Ombudsman staff reported witnessing R2's key was able to open other resident doors. During the facility visit on 02/09/2024, ED Garcia reported to LPA Brown of not having any information why R2 has a key that can open other resident doors. **Continuation in LIC9099C** **This is an Amended Copy**
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
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 5
Control Number 56-AS-20231204083515
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: 05/08/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In addition, ED Garcia confirmed to LPA Brown that they immediately contacted the local locksmith the following work weekday to replace the residents lock and key.

Based on LPA Brown’s observations and records review, the preponderance of evidence standard has been met, and therefore the above allegation of Resident has access to a master key to open facility doors is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations, (Title 22, Division 6 & Chapter 8) is being cited on the attached LIC9099D.

An exit interview was conducted where this report, LIC9099, LIC9099D, and Appeal Rights were discussed and provided to ED Griselda Torres Garcia.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20231204083515
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2024
Section Cited
CCR
87468.2(a)(1)
1
2
3
4
5
6
7
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in... (1) To have a reasonable level of personal privacy in accommodations,...This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated that residents’ locks and keys were already replaced to ensure that the assigned key to a resident can only open their own room. Proof of Locksmith Service already submitted to LPA Brown.
Licensee stated to train all staff on CCR 87468.2(a)(1) and submit proof of Training Log to LPA Brown on Plan of Correction (POC) due date.
8
9
10
11
12
13
14
Based on interview and records review, the Licensee did not comply with the section cited above by not ensuring that residents at the facility have personal privacy in accommodations as evidenced of Resident #1 (R1) having a key that can open other resident doors which poses an immediate health, safety and personal rights risks to residents in care.

8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
12/04/2023 and conducted by Evaluator Melody Brown
COMPLAINT CONTROL NUMBER: 56-AS-20231204083515

FACILITY NAME:GARDENS OF RIVERSIDE, THEFACILITY NUMBER:
331800063
ADMINISTRATOR:GRISELDA T. GARCIAFACILITY TYPE:
740
ADDRESS:10849 ARLINGTON AVETELEPHONE:
(951) 637-8844
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:98CENSUS: 86DATE:
05/08/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Executive Director Griselda Torres GarciaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure a safe environment to residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/08/2024 at 01:45 PM, Licensing Program Analysts (LPA) Melody Brown and Sarina Ramirez met with Executive Director Griselda Torres Garcia at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation.

The investigation was conducted by LPA Melody Brown. The investigation consisted of file review and
interviews with relevant parties. The allegation indicates that Staff does not ensure a safe environment to residents in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Three (3) of four (4) residents interviewed indicated that staffs at the facility ensure a safe environment for them as staffs are checking on them multiple times a day to make sure they are safe and appropriately ***Continuation in LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20231204083515
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: 05/08/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
provide their needed care and supervision. Three (3) of three (3) staffs interviewed indicated that they are
ensuring a safe environment on all their residents at the facility as they are all checking on their residents every two (2) hours or every hour or every 30 minutes if needed. Staff interviews revealed that there's no incident happened at the facility that a staff did not ensure safe environment for their residents. During the facility visit on 02/09/2024, LPA Brown observed staffs checking on their residents to ensure that they are safe or provide assistance if needed.

Based on the evidence, the allegation that Staff does not ensure a safe environment to residents in care is UNSUBSTANTIATED. A finding that the complaint is 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Executive Director Griselda Torres Garcia.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5