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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880741
Report Date: 07/27/2023
Date Signed: 07/27/2023 01:30:17 PM


Document Has Been Signed on 07/27/2023 01:30 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
RIVERSIDE, CA 92507



FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331880741
ADMINISTRATOR:BERCOVICH, MOISES UFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:150CENSUS: 58DATE:
07/27/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Adam ZenouTIME COMPLETED:
11:41 AM
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Regional Manager (RM) Reyna Lacey with the Riverside Adult & Senior Care (ASC) Regional Office, RM Angela Kendrick with the Woodland Hills South ASC Regional Office and Bureau Chief Hao Nguyen with Central Applications Bureau held an office meeting with Adam Zenou and Moises Bercovich, CEOs of Riverside Retirement VI.

During the office meeting, the recent addition of Riverside Retirement VI to the licensee was discussed. Mr. Zenou acknowledged he understood the history of the facility. Mr. Zenou reported that the following has been done to assist in managing the facility: contracting with staffing agencies to hire additional staff, hiring of a Wellness Director, hiring of a new Administrator, executing a new dining contract to improve food and he also identified working with a consultant to ensure conformity to regulations.

Mr. Zenou reported that a meet and greet has been conducted with residents and their families to engage in conversation about the management changes.

RM Lacey advised on keeping open communication with the Riverside ASC Regional Office, to allow the Regional Office to provide support and guidance.

An exit interview was conducted where this report was discussed and provided.
SUPERVISOR'S NAME: Kimberly LewisTELEPHONE: (951) 248-0310
LICENSING EVALUATOR NAME: Reyna LaceyTELEPHONE: 951-248-0341
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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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