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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800063
Report Date: 08/14/2024
Date Signed: 08/14/2024 01:18:43 PM


Document Has Been Signed on 08/14/2024 01:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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, THEFACILITY NUMBER:
331800063
ADMINISTRATOR:GRISELDA T. GARCIAFACILITY TYPE:
740
ADDRESS:10849 ARLINGTON AVETELEPHONE:
(951) 637-8844
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:98CENSUS: 81DATE:
08/14/2024
TYPE OF VISIT:Case Management - DeficienciesANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Executive Director Griselda Garcia.TIME COMPLETED:
01:30 PM
NARRATIVE
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On 08/14/2024 at 12:30 PM Licensing Program Analysts (LPAs) Melody Brown and Renese Howell-Small met with Executive Director Griselda Garcia at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office for a Case Management Deficiency. LPAs Brown and Howell-Small explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation.

Through the information gathered during the investigation, it was confirmed by documents review and staff interviews that the facility did not appropriately arrange and assist residents on setting-up a medical appointment for a podiatrist to visit the facility to cut residents toenails. Interviews with five (5) of seven (7) residents indicated that staffs at the facility are not cutting their toe nails. Interviews with four (4) of four (4) staffs revealed that they do not cut their residents toenails as podiatrist must cut their toenails. During the visit on 03/05/2024, Staff #2 (S2) reported to LPA Brown that S2 set-up a podiatrist appointment for the residents at the facility the following week. Per documents review, the facility does not have regular appointments set-up for podiatrist to cut the residents toenails at the facility. During the visit on 03/05/2024 and 03/12/2024, LPA Brown observed Resident #1 (R1), Resident #7 (R7), Resident #9 (R9), Resident #11 (R11) and Resident #12 (R12) toe nails long, not cut. Deficiency will be issued.

An exit interview was conducted where this report LIC809, LIC80D, and Appeal Rights were discussed and provided to Executive Director Griselda Garcia.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/14/2024 01:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2024
Section Cited
CCR
87465(a)(1)

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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate...This requirement is not met as evidenced by:
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Licensee stated to submit a 2024 plan of medical appointments/schedule with podiatrist for the residents at the facility to LPA Brown on Plan of Correction (POC) due date.
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Based on interviews, observations and records review, the Licensee did not comply with section cited above by not arranging and assisting residents for a regular medical appointment schedule with a podiatrist to cut their toenails which pose potential health, safety, and personal rights risks to residents in care.
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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: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024
LIC809 (FAS) - (06/04)
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