331880741-7-25-2023-18-AS-NBRN-CVZUQN-20230925154726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 07/25/2023
Date Signed: 07/25/2023 06:36:01 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
07/06/2021 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210706150406

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: 65	DATE:	07/25/2023
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Crystal Maldonado, Business Office Manager		TIME COMPLETED:	07:00 PM

ALLEGATION(S):

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Residents left in soiled diapers.
Residents not being provided adequate food services.
Resident belonging is being stolen.

INVESTIGATION FINDINGS:

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This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegations mentioned above. Investigation included interview of residents, tour of the kitchen and LPA observation of meal service, assessment of the food supply, and review of the menus. LPA reviewed the facility theft and loss policy and requested incontinent care tracking. LPA reviewed kitchen staff records and obtained copies of their Riverside food handlers cards. Investigation reveled the following information: It is alleged that residents are left in soiled diapers. The facility is using incontinent care tracking/bowel movement logs for residents that do not communicate when they need incontinent care. Two (2) residents were able to be interviewed regarding incontinent care. Two (2) of two (2) residents interviewed tell LPA that they are able to pull the cord next to their bed when they need assistance with incontinent care. Both report that staff will respond, although some quicker than others. Neither report being left too long in a soiled diaper.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023

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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Control Number 18-AS-20210706150406

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: 07/25/2023

NARRATIVE

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It is alleged that residents have been served raw chicken. LPA interviewed eight (8) residents regarding meal service. Seven (7) of eight (8) residents interviewed report that they have not been served raw chicken. LPA notes that employee food handler cards are current. It is alleged that several residents credit cards have been coming up missing. LPA interviewed eight (8) residents regarding stolen property. Three (3) residents tell LPA they have not had any items stolen from them. One (1) resident tells LPA a debit card came up missing. One (1) resident tells LPA that $100.00 dollars came up missing. One (1) resident reports various items came up missing but they wouldn't hazard to guess who took it. One (1) resident tells LPA that they have had items missing but knows it wasn't a staff member. One (1) resident tells LPA another resident likes to steal their wooden clothes hangers. All residents have keys to their own bedrooms. The facility theft and loss policy is reviewed and initialed at the time of admission. There is not enough evidence to support whether the facility is responsible for the missing items.

Based on the available information, we have found the complaint allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

A copy of this report is being reviewed with and furnished to the facility representative

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023

LIC9099 (FAS) - (06/04)

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