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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 01/24/2024
Date Signed: 01/24/2024 05:40:11 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
01/11/2021 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210111100922
FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331880741
ADMINISTRATOR:GEMMA DEOSOFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:150CENSUS: 67DATE:
01/24/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Administrator, Morgan WilliamsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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9
Residents are not receiving an adequate amount of food
Residents were not assisted to the restroom
INVESTIGATION FINDINGS:
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5
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On 1/24/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to the facility to conclude the investigation into the allegations listed above. LPA met with Administrator, Morgan Williams and explained the purpose of the visit. During the investigation, LPA reviewed information provided from staff and resident interviews and record review.

Regarding the allegation of, "Residents are not receiving an adequate amount of food," it was reported that residents in care were not being fed adequately and only receive a soup or sandwiches for meals. The administrator overseeing the facility during the alleged incident timeframe, Gemma Deoso, was interviewed and reported that the facility maintained a sufficient food supply for the residents in care and that the facility received deliveries twice per week. It was also reported that sandwiches were often requested by residents who did not like the main meal provided. A review of the facility's menu and food supply invoices was attempted but the reports were no longer on file at the facility. The interviews conducted did not corroborate or refute the validity of the allegation. As a result, the allegation of “Residents are not receiving an adequate amount of food” 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (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)
Page: 1 of 5
Control Number 18-AS-20210111100922
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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Regarding the allegation of, "Residents were not assisted to the restroom" it was reported that Resident 1 (R1) and 2 (R2) were left in soiled diapers and other residents were left in soiled diapers for an entire weekend. LPA reviewed R1’s Physician Report (LIC602A) dated 02/22/2018, which indicates R1 has no capacity to take care of their own toileting needs. R1’s Appraisal/Needs and Services Plan (LIC 625), dated 06/06/2020, indicates R1 requires assistance with toileting. The facility was unable to locate R2’s records for LPA’s review. Administrator Williams reported that the facility changed their management company on 7/24/2023, and R2’s records were not transferred to the new management team. 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 Deoso reported R1 did not use adult diapers in January of 2021. Administrator Deoso denied having knowledge of other residents being left in soiled diapers for extended periods of time. Additional interviews revealed that residents have been found in soiled adult diapers. A specific time frame as to how long residents remained in soiled diapers could not be obtained. Based on interviews conducted, the allegation of “Residents were not assisted to the restroom” is deemed 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 HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (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)
Page: 2 of 5
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
01/11/2021 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210111100922

FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331880741
ADMINISTRATOR:GEMMA DEOSOFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:150CENSUS: 67DATE:
01/24/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Administrator, Morgan WilliamsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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2
3
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9
Resident’s hygiene needs are not being met
Facility carpets were soiled with urine
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
On 1/24/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Administrator, Morgan Williams, and explained the purpose of the visit. During the investigation, LPA reviewed information provided from staff and resident interviews and records reviewed.


Regarding the allegation of, "Resident’s hygiene needs are not being met," it was reported that residents in care were not receiving showers. A review of the facility's Program Statement stated, "Residents are to have a full bath/shower according to their needs and preferences, and at least twice per week." The administrator at that time, Gemma Deoso, was interviewed and reported the facility was having a staffing shortage in January of 2021. Administrator Deoso, reported there was one resident who did not receive a shower for one week and when offered a shower the following week, declined. Based on record review and interviews conducted, this allegation is deemed SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. This poses a potential health and safety risk to residents in care. The facility will be cited pursuant to Title 22, regulation 87468.2(a)(4).
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (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)
Page: 3 of 5
Control Number 18-AS-20210111100922
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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Regarding the allegation of, "Facility carpets were soiled with urine," it was reported that yellow stains/urine puddles were observed on the carpets of the first and second floors of the facility. Administrator Deoso stated that there was a resident that habitually urinated on the facility floor. Administrator Deoso added that the resident refused to wear diapers and would urinate in different locations throughout the facility. Administrator Deoso added that a facility staff observed the resident having bladder accidents at the facility. Based on interviews conducted, the allegation of “Facility carpets were soiled with urine” is deemed Substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The facility will be cited pursuant to Title 22, regulation 87303(a).

An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Williams along with LIC9099-D and Appeal Rights.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (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)
Page: 4 of 5
Control Number 18-AS-20210111100922
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/02/2024
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights...87468.2(a)(4) To care, supervision, and services that meet their individual needs and are delivered by staff.... This requirement was not met as evidenced by:
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Administrator Williams stated that they have contracted a staffing agency to avoid inadequate staffing.
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Administrator Deoso reported the facility was facing a staffing shortage in January of 2021, and R1 did not receive a shower for one (1) week. This poses a potential health and safety risk to residents in care.
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Type B
02/02/2024
Section Cited
CCR
87303(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met as evidenced by:
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Administrator Williams stated she is in the process of changing the facility carpet.
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Yellow stains/urine puddles were observed in the facility's floors and Administrator Deoso stated that there was a resident that habitually urinated on the facility floor.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5