<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
331880741
Report Date:
03/30/2021
Date Signed:
04/01/2021 09:18:39 AM
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 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:
57
DATE:
03/30/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:30 AM
MET WITH:
Gemma Deoso, Administrator
TIME COMPLETED:
05:45 PM
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
Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to amend a report issued on 03/26/21 for complaint #18-AS-20210301135754.
SUPERVISOR'S NAME:
Reyna Lacey
TELEPHONE:
(951) 836-3135
LICENSING EVALUATOR NAME:
Stephanie Torres
TELEPHONE:
(951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE:
03/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1