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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800063
Report Date: 11/02/2020
Date Signed: 11/02/2020 03:12:02 PM



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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/08/2020 and conducted by Evaluator Robbie Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200508082546
FACILITY NAME:GARDENS OF RIVERSIDE, THEFACILITY NUMBER:
331800063
ADMINISTRATOR:STEPHANIE ODENFACILITY TYPE:
740
ADDRESS:10849 ARLINGTON AVETELEPHONE:
(951) 637-8844
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:98CENSUS: 79DATE:
11/02/2020
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Shannon Gordon, Head NurseTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Staff member(s) mishandle residents' medications
Staff member makes inappropriate comments in front of residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst Robbie Johnson contacted the facility to deliver findings regarding the above allegations via telephone due to COVID-19. LPA identified herself and discussed the purpose of the call and the elements of the above allegations with Shannon Gordon, Head Nurse.

The Department conducted investigation of allegation to include interviews and records review. Allegation #1 Interviews with several staff revealed that residents medications are not mishandled and are administered correctly. Interviews with residents revealed that staff administers medications per their physician's orders. LPA reviewed the medication and administration records (MARS) for several residents. Based on a review of the MARS it appears that resident medications are dispensed per physicians orders. LPA could not corroborate that medications are mishandled by staff. The allegation is UNSUBSTANTIATED. Allegation #2 interviews with several residents revealed that no staff has made inappropriate comments in their prescence. Staff interviews revealed that residents are treated with respect and are not spoken to inappropriately. LPA could find no evidence that staff makes inappropriate comments in front of residents. The allegation is UNSUBSTANTIATED. ** continued on next page**
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Robbie JohnsonTELEPHONE: (951) 248-0304
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2020
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 2
Control Number 18-AS-20200508082546
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
RIVERSIDE, CA 92507
FACILITY NAME: GARDENS OF RIVERSIDE, THE
FACILITY NUMBER: 331800063
VISIT DATE: 11/02/2020
NARRATIVE
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 A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged abuse occurred.

A copy of this report was reviewed with and provided to Shannon Gordon via email.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Robbie JohnsonTELEPHONE: (951) 248-0304
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2