331880741-10-4-2024-18-AS-TAGD-D9QU2Z-20241004151247

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 09/22/2024
Date Signed: 10/04/2024 02:39:56 PM

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
12/21/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 18-AS-20231221103027

FACILITY NAME:	ARLINGTON RIVERSIDE SENIOR COMMUNITY		FACILITY NUMBER:	331880741
ADMINISTRATOR:	WILLIAMS, MORGAN E		FACILITY TYPE:	740
ADDRESS:	4609 ARLINGTON AVE		TELEPHONE:	(951) 462-1025
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	0	CENSUS: 102	DATE:	09/22/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Molly Bowie - Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not follow resident's care plan
Staff did not ensure resident's physical therapy needs were met
Staff left resident in a wet bed for long periods of time
Staff did not provide water to resident in care
Staff did not provide meals to resident in care

INVESTIGATION FINDINGS:

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This report is amended to rectify typographical error. No change in findings.

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Executive Director, Molly Bowie and explained the reason for the visit.

LPA conducted a physical plant tour at 11:35 AM, requested copies of facility documents relevant to the investigation at 11:55 AM, reviewed records between 12:00 PM to 1:00 PM and interviewed staff and residents between 1:00 PM to 2:00 PM. Regarding the allegation that staff did not follow resident's care plan, it was alleged that Resident #1 (R1) was not receiving the services promised following R1's spinal surgery. LPA attempted to call R1 today at 11:35 AM and the phone listed is no longer in service. LPA's record review today revealed that R1 was admitted at this facility on 10/19/23 from a Skilled Nursing Facility (SNF). R1 was then hospitalized on 12/26/23 due to a medical condition and did not return to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2024

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 3

Control Number 18-AS-20231221103027

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ARLINGTON RIVERSIDE SENIOR COMMUNITY	FACILITY NUMBER: 331880741
	VISIT DATE: 09/22/2024

NARRATIVE

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(continued from LIC 9099)

Further review also revealed that R1 had no bowel or bladder impairment, was able to feed own self and able to administer own medication. LPA did not find any record pertaining to the services and/or plan of care that was not being followed by the staff. Additionally, it was also alleged that R1 has not been moved while in bed and has only been given three (3) bed baths since arriving at the facility. LPA Goodrich's interview with two (2) staff on 12/27/23 revealed that R1 was able to do own shower and bed bath but sometimes refused to shower when offered by the staff. LPA's record review today also revealed that R1 was able to move while in bed but needs assistance getting up.

Regarding the allegation staff did not ensure resident's physical therapy needs were met, it was alleged that R1 had not received physical therapy and is in pain. LPA Goodrich's interview with a former medication staff on 12/27/23 revealed that they tried to put R1 on Home Health Services to have physical therapy but there was no doctor's order to work with. LPA's record review today revealed that there was a physician's order for physical therapy only on 12/21/23 but R1 was sent to Urgent Care on 12/26/23 and did not go back to the facility.

Regarding the allegation staff left resident in a wet bed for long periods of time, LPA's record review today revealed that R1 was not incontinent. A review of a prior assessment completed by another entity stated that R1 had occasional incontinence both bowel and bladder. LPA's interview with care staff today at 1:03 PM who was here when R1 was still here, revealed that R1 was able to change themselves most of the time and used adult pull-ups diapers. The staff interviewed also stated they also helped R1 when R1 used a regular diaper. LPA's interview with five (5) incontinent residents today also revealed that five (5) out of five (5) residents interviewed were changed by the staff timely. None of the residents indicated having to wait for long periods of time to be changed.

Regarding the allegation staff did not provide water to a resident in care, LPA’s interview with care staff today at 1:03 PM who was here when R1 was still here, revealed that R1 purchased a specific brand of bottled water. Care staff stated that they were aware because they were responsible for bringing the case of water to R1's room upon delivery. Further, staff stated that even before R1 ran out of bottled water, R1 would reorder online to replenish own personal stock of bottled water. LPA's observation during this visit also revealed there are water stations throughout the facility complete with Styrofoam drinking cups. During a facility tour of random residents' rooms visited, it was observed that they had their own water bottles or pitcher of water by their bedside. (continued on LIC 9099-C, page 3)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20231221103027

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ARLINGTON RIVERSIDE SENIOR COMMUNITY	FACILITY NUMBER: 331880741
	VISIT DATE: 09/22/2024

NARRATIVE

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(continued from LIC 9099-C, page 3)

Regarding the allegation staff did not provide meals to resident in care, it was alleged that staff forgot to deliver dinner to R1 four (4) times. LPA's interview with kitchen staff today at 1:30 PM revealed that tray services are prepared first by the kitchen staff and then the care staff deliver to the resident's room. Care staff usually delivers within the mealtime period (e.g. lunch is from 12:00 PM to 1:00 PM) by at least 12:30 PM. Further interview also revealed that there was no incident, nor complaint that a resident missed any meal because they always have additional meals in case a resident wants seconds. LPA's interview with care staff today at 1:03 PM who was here when R1 was still here, revealed that R1 did not miss any meals and they always deliver R1's food on time.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

Due to the facility closure on April 15, 2024, a copy of this report and the appeals rights (LIC 9058) will be sent via email to Adam Zenou at Adam@skilledmanagementco.com and another certified copy vis USPS to Mr. Zenou's last known address.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2024

LIC9099 (FAS) - (06/04)

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