331880741-1-11-2024-18-AS-RSTS-CZN534-20240119183518

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 01/11/2024
Date Signed: 01/11/2024 01:54:47 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
12/27/2021 and conducted by Evaluator Janette Romero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211227094300

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: 67	DATE:	01/11/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Administrator, Morgan Williams		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Facility failed to provide a comfortable environment for resident

INVESTIGATION FINDINGS:

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On 1/11/2024, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to conclude the investigation into the allegation listed above. LPA met with Administrator, Morgan Williams, and explained the purpose of the visit.

Regarding the allegation of, "Facility failed to provide a comfortable environment for resident", it was alleged that Resident 1 (R1) was yelled at by their roommate, Resident 2 (R2). It was reported that R2 turned on their radio very loud and the room light at 3:00 a.m. LPA reviewed the information provided by the administrator at that time, Kurt Niebres and conducted one resident interview.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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-20211227094300

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: 01/11/2024

NARRATIVE

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Administrator Niebres stated that the facility generally placed residents in a shared bedroom for one (1) week and if there were no complaints, both residents would continue to share the room. Administrator Niebres reported that R1 and R2 were placed in the same room after a compatibility assessment was conducted.

Administrator Niebres reported that R1 complained about R2 after sharing the room for three (3) days and as a result, R2 was moved to a different room. Administrator Niebres stated that the residents disagreed over the television being on or the room being a mess.

On 1/2/2024, LPA interviewed R1. The information provided by R1 did not corroborate the allegations. R1 reported their roommate vacated their room after the first night, and recalled having an amicable relationship with their roommate.

Administrator Williams reported that the facility changed their management company on 7/24/2023. LPA was informed that R2 moved out prior to the change and R2’s records were not transferred to the new management team. As a result, LPA was unable to obtain R2's contact information for an interview.

During the investigation, LPA was unable to corroborate information obtained. The facility reported that R2 was moved to a different room after R1 complained. R1 reported their roommate unoccupied their bedroom after sharing the space for one (1) night, and added that they had a good relationship with their roommate during their stay at the facility.

Based on interviews conducted and record review, LPA determined that the allegation of “Facility failed to provide a comfortable environment for resident” is Unsubstantiated. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Williams along with a Confidential Names List (LIC811).

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

LIC9099 (FAS) - (06/04)

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