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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 06/05/2024
Date Signed: 06/05/2024 11:26:38 AM

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
03/19/2024 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240319160320
FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331880741
ADMINISTRATOR:WILLIAMS, MORGAN EFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:0CENSUS: 92DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Morgan WilliamsTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility issued eviction unlawful notices to several residents.
INVESTIGATION FINDINGS:
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On 6/5/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to deliver findings regarding the above allegation. LPA met with Administrator, Morgan Williams was informed of the purpose of the visit.

Regarding the allegation, “Facility issued unlawful eviction notices to several residents” it was alleged Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), and Resident 4 (R4) are Supplemental Security Income (SSI) recipients who received a rent increase and were served with unlawful eviction notices due to non-payment. LPA reviewed R1-R4’s admission agreements. Per R1 and R2’s admission agreements, the funding source for both residents is not SSI. R1 was interviewed and reported they received a rent increase letter effective January 2024. R1 added they did not pay the rent increase and received an eviction notice due to non-payment.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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 2
Control Number 18-AS-20240319160320
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: 06/05/2024
NARRATIVE
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R2 was interviewed and reported they also received a rent increase, and the increase was not paid. Upon review of the eviction notice, it was issued for non-payment. Per R3 and R4’s admission agreements, the funding source for both residents is SSI. Interviews revealed R3 and R4 were not issued rent increases and received eviction notices for not paying the standard SSI rate. R3 and R4 were interviewed and corroborated the information.

This agency has investigated the complaint alleging "Facility issued eviction unlawful notices to several residents". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to Administrator Williams.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2