331880741-12-23-2021-18-AS-JESL-CTAW2L-20230630165427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 12/23/2021
Date Signed: 12/23/2021 01:24:18 PM

Unsubstantiated

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
11/15/2021 and conducted by Evaluator Stephanie Torres

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: 60	DATE:	12/23/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kurt Niebres, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not properly administrating medications
Resident is unable to access their shower
Facility is charging residents for services not rendered

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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

Regarding the allegation, "Staff are not properly administrating medications," it was alleged staff did not appropriately administer medication to residents in care. The LPA initiated the investigation on November 19, 2021; staff/resident interviews were conducted, records reviewed and copies of pertinent information were obtained. R1 was interviewed and reported they have not been receiving their medication appropriately. R1 stated two (2) of their daily medications have not been filled and therefore, not been provided. A review of R1's Medication Administration Record (MAR) for the month of November 2021 revealed one (1) of R1's daily medications may not have been dispensed. An audit of R1's medication revealed no additional medications present. Therefore, due to conflicting information, this allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021

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-20211115143027

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: ARLINGTON RIVERSIDE SENIOR COMMUNITY	FACILITY NUMBER: 331880741
	VISIT DATE: 12/23/2021

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

Pertaining to the allegation, "Resident is unable to access their shower," it was alleged Resident Two (R2) is unable to access their shower due to physical limitations and facility staff have not accommodated the resident with a more accessible shower. R2's Physician's Report for Residential Care Facilities for the Elderly (RCFE) revealed R2 does not have a capacity to care for their own bathing needs. R2 was interviewed and reported they can bathe independently, however, they do have difficulty getting into the shower due to the threshold step. The LPA inspected R2's shower and observed the step measured at six (6) inches. The LPA also observed R2's shower to have boxes presently being stored there. Interviews also indicate R2 has, on occasion, declined showers from staff. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

With regard to the allegation, "Facility is charging residents for services not rendered," it was alleged the facility is charging residents for transportation though are not providing the service. Records review was conducted for four (4) residents. An itemized list of charges could not be provided by facility staff. A review of the facility's Plan of Operation revealed the facility should be providing transportation services to residents in care, however, according to staff the service is not being provided. Resident interviews revealed no knowledge of whether they are charged for transportation or not. Therefore, based on insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No citation have been issued at this time.

This report was reviewed with Niebres and a copy was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2