331880741-1-24-2024-18-AS-RSTS-CZZRX4-20240131122404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 01/24/2024
Date Signed: 01/24/2024 05:08:16 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
04/01/2021 and conducted by Evaluator Janette Romero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210401134706

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:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Administrator, Morgan Williams		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Resident was denied their medication
Resident's medication was not given according to physician's direction

INVESTIGATION FINDINGS:

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On 1/24/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Administrator, Morgan Williams and explained the purpose of the visit. During the investigation, LPA conducted a record review, and reviewed staff and resident interviews.

Regarding the allegation, "Resident was denied their medication" it was reported that Resident #1 (R1) experienced pain and requested their pain medication from Staff #1 (S1) but was denied. LPA reviewed R1’s physician’s report, which noted pain medication was prescribed every 4 hours on an as needed basis. LPA conducted a record review and confirmed that R1 required Pro Re Nata (PRN) medication management. LPA attempted to review R1’s Medication Administration Record (MAR) from March and April of 2021, but the facility was unable to locate R1’s MAR. Administrator Williams reported that the facility changed their management company on 7/24/2023, and some of R1’s records were not transferred to the new management team.

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: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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-20210401134706

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: 01/24/2024

NARRATIVE

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Administrator Williams added that the previous management team removed resident records from the facility, including records of residents that remained in the facility during the transition. As a result, the new management team continues to have trouble locating past resident records that are still within the record retention period. Administrator Williams stated that the new management team updated all the remaining residents’ records and transitioned to electronic MARs to have records readily available for CCLD’s review. In addition to the investigation of “Resident was denied their medication,” Department staff overheard R1 request their pain medication from S1, and S1 informed R1 that it was not time for their medication, as they had already received their medication. Additional interviews did not corroborate the allegations. Based on observations, record review and interviews conducted, LPA determined the allegation of “Resident was denied their medication” 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.

Regarding the allegation of, “Resident’s medication was not given according to physician’s directions”, it was reported that R1 was scheduled to receive their medication at 7:00 a.m. and S1 dispensed their medication at 10:00 a.m. LPA attempted to review R1’s physician’s orders and medication list from March and April of 2021. Due to the removal of records from the previous management team, Administrator Williams was unable to locate R1’s physician’s orders, medication list or MAR from the alleged incident time frame. LPA reviewed R1’s physician’s report, which noted R1 required medication management. Department staff witnessed S1 inform R1 that it was not time for their medication, as they had already received their medication. Additional interviews did not corroborate the allegations. Based on observations, record review and interviews conducted, LPA determined the allegation of “Resident’s medication was not given according to physician’s directions” 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: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC9099 (FAS) - (06/04)

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