331880741-10-13-2023-18-AS-NBRN-CXMP4A-20231116095848

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 10/13/2023
Date Signed: 10/13/2023 02:11:05 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
07/27/2021 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210727083244

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: 70	DATE:	10/13/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:			TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff stole resident credit card.
Staff are not qualified.
Staff are not assisting resident with her incontinence.
Staff do not assist resident with ambulation.
Staff uses resident diapers for other residents.
Staff did not assist resident with administration of medications.
Staff are not keeping accurate records of resident payments.

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, review of one resident record, review of four staff records, review of Community Care Licensing Incident Reports received. LPA obtained copies of pertinent documents. Investigation revealed the following:

It is alleged that an unknown staff stole the credit card of R1. Review of employee records and facility staff review of historical records stored did not reveal an employee with the name identified by R1 having worked at the facility during the time of the allegation. R1 did not know the names of the alleged staff.

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: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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-20210727083244

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: 10/13/2023

NARRATIVE

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It is alleged that the facility is not hiring qualified staff. LPA reviewed four (4) employee files. Four (4) of four (4) employee records revealed the employees to be hired are over the age of 18, have received the required initial training, and are fingerprint cleared. There is no available evidence at this time that indicates staff hired are not qualified.
It is alleged staff are not assisting resident with incontinent care and that staff uses resident diapers for other residents. LPA interviewed Seven (7) residents which currently receive incontinent care. Four (4) of seven (7) residents interviewed regarding incontinent care tell LPA that they receive the assistance that they need and have access to their own incontinent supplies. Three (3) of seven (7) were not able to be interviewed due to medical status. Interviews did not corroborate the allegation. It is alleged that staff do not help R1 with ambulation. LPA interviewed five (5) residents that use a wheelchair. Five (5) of five (5) interviewed tell LPA that they are assisted when needed. LPA reviewed records for R1. Physician’s report dated 08/21/2020 revealed that R1 can communicate their needs and needs assistance with self care and is identified as non ambulatory. LPA review of record does not indicate that resident ambulates with assistance or has orders to ambulate. It is alleged that R1 didn’t get her pain meds for a week because the staff did not order them on time. LPA request for review of R1’s medication records for 2021 did not provide any information to verify the allegation. There were no available resident notes to review for 2021. LPA review of Community Care Licensing incident report log did not reveal a reported medication error for R1 during 2021. It is alleged staff are not keeping accurate records of resident payments. Interview with Business Office Manager revealed that the facility currently tracks payment on a ledger through a system called Yardi. LPA is unable to obtain any information that there was poor record keeping based on the information received through review of R1’s record.

We have found the complaint allegation is unsubstantiated, although the allegation may have happened or is 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: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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