331880741-6-12-2023-18-AS-JESL-CTAW2J-20230630165426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 06/12/2023
Date Signed: 06/12/2023 08:44:46 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
11/15/2021 and conducted by Evaluator Stephanie Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211115143027

FACILITY NAME:	ARLINGTON RIVERSIDE SENIOR COMMUNITY		FACILITY NUMBER:	331880741
ADMINISTRATOR:	GEMMA DEOSO		FACILITY TYPE:	740
ADDRESS:	4609 ARLINGTON AVE		TELEPHONE:	(951) 462-1025
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	150	CENSUS: 76	DATE:	06/12/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Kurt Niebres, Administrator		TIME COMPLETED:	08:45 AM

ALLEGATION(S):

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Staff handled resident in rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegation. The LPA met with Administrator, Kurt Niebres, and informed him of the purpose for her visit.

Regarding the allegation, "Staff handled resident in rough manner," it was alleged Staff One (S1) is rough with residents in care, causing bruising. Staff/resident interviews were conducted. It was reported S1 has been rough with residents in care; however, details regarding the circumstances of those incidences could not be provided. Resident One (R1), who reported S1 has been rough with them, reported sustaining bruises as a result of interaction with S1. R1, however, also reported bumping into objects on occasion and bruising easily. S1 was interviewed and denied the allegation. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED. A finding 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 the alleged violation occurred. This report was reviewed with Niebres, and a copy was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 782-4807
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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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