331880741-9-20-2024-18-AS-TDAN-D9DKW2-20240923081505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 03/06/2024
Date Signed: 09/20/2024 04:15:31 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
01/31/2024 and conducted by Evaluator Stephanie Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240131151911

FACILITY NAME:	ARLINGTON RIVERSIDE SENIOR COMMUNITY		FACILITY NUMBER:	331880741
ADMINISTRATOR:	WILLIAMS, MORGAN E		FACILITY TYPE:	740
ADDRESS:	4609 ARLINGTON AVE		TELEPHONE:	(951) 462-1025
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	150	CENSUS: 71	DATE:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Morgan Williams, Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility staff did not ensure the facility is kept in clean and sanitary conditions for residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to continue 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 by the Department alleging the facility common area couches and carpeting were stained with urine, and the common areas were very dusty. An inspection was conducted by the LPA on 02/08/2024. The LPA observed the hallway carpeting to be stained, though the source of the stains could not be determined. The inspection did not reveal common area couches to be stained or dusty. Staff and resident interviews revealed the facility does clean the carpets throughout the facility in sections, so as not to block an entire passageway. Four resident interviews reported staff do clean the carpets at the facility. Resident interviews could provide no information as to the last time the carpets were cleaned. According to two staff interviews, the facility has ensured the carpets and furniture are cleaned. One interview reported that residents do not chose to walk around areas that are sectioned off for cleaning, resulting in continued stains on the

Unsubstantiated

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: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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-20240131151911

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: 03/06/2024

NARRATIVE

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carpet. Therefore, based on interviews and observation, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

A copy of this report was sent to the licensee's last known address via USPS certified mail due to facility closure.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

LIC9099 (FAS) - (06/04)

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