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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800063
Report Date: 08/16/2021
Date Signed: 08/16/2021 02:35:41 PM

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
RIVERSIDE, CA 92507
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: 85DATE:
08/16/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Shannon Gordon, Resident Services DirectorTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to commence a case management investigation. The LPA identified herself and discussed the purpose of the visit with Resident Services Director, Shannon Gordon.

The Department received a Special Incident Report (SIR) on August 11, 2021 pertaining to Client One (C1). The SIR detailed Resident One (R1) complaining to staff members of an incident involving Staff One (S1) allegedly being sexually inappropriate with C1 on an unknown date. It was alleged C1 had been awakened by someone moving their underwear. Per the SIR, C1 awoke and observed S1 standing above their bed.

On this visit the LPA conducted resident interviews and requested records. Gordon reported S1 is still employed, though suspended until the completion of an internal investigation. The LPA will review reports received from the facility and follow-up, if necessary. No health and safety concerns were observed on this visit.

An exit interview was conducted with Gordon and a copy of this report was provided.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
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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