331880741-3-14-2024-18-AS-RSTS-D4U269-20240430170641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 11/09/2023
Date Signed: 03/14/2024 04:30:23 PM

Unfounded

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
10/03/2023 and conducted by Evaluator Stephanie Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20231003144946

FACILITY NAME:	ARLINGTON RIVERSIDE SENIOR COMMUNITY		FACILITY NUMBER:	331880741
ADMINISTRATOR:	BERCOVICH, MOISES U		FACILITY TYPE:	740
ADDRESS:	4609 ARLINGTON AVE		TELEPHONE:	(951) 462-1025
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	150	CENSUS: 73	DATE:	11/09/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Morgan Williams, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is illegally raising rates for a resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegation. The LPA met with Administrator, Morgan Williams, and informed her of the purpose for the visit. A report was received alleging the facility raised the monthly rate of Resident One (R1) by $2,500. The LPA reviewed R1's file and observed a letter, dated 10/01/2023, informing R1 of the increase to $4,500 monthly, effective 01/01/2024, due to current rates not covering the community costs. An interview with a witness corroborated the letter informing R1 of the rate increase letter was received on or around 10/01/2023. R1's Admission Agreement revealed the monthly rate was $2,453 when it was signed on 09/13/2019. The admissions agreement did not identify the funding source. An interview with a witness revealed R1 was admitted to the facility as a private pay resident. A review of the facility's Plan of Operation was reviewed and no rate increase capacity was observed to be noted. Therefore, based on the above information, this allegation is deemed UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Administrator Williams; this report was reviewed and a copy was provided. NOTE: This report was amended on 03/14/2024.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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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