331880741-2-26-2021-18-AS-NBRN-C48TGL-20210622144320

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 02/26/2021
Date Signed: 02/26/2021 01:53:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-26
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/26/2020 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200826141739

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: 63	DATE:	02/26/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Gemma 'Gigi' Deoso, administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Residents are not provided a comfortable room temperature
Staff did not assist resident with toileting needs in a timely manner
Residents are not receiving adequate meals

INVESTIGATION FINDINGS:

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On 2/26/21 Licensing Program Analyst (LPA) Shaunte Henry conducted a tele-inspection due to COVID-19 in order to deliver the findings for the above allegations. LPA Henry spoke to administrator Gemma Deoso and explained the purpose of the tele-inspection.

The investigation consisted of interview and document reviews. Resident interviews revealed residents experienced comfortable room temperatures. Resident interviews revealed staff respond to resident all pendants in a timely fashion and toileting needs are met. Resident interviews revealed residents are receiving adequate meals. 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, therefore all allegations are unsubstantiated at this time.

An exit interview was conducted where this report and LIC 811 were discussed with and provided to the administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021

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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