331880741-1-26-2021-18-AS-NBRN-BXPQF9-20210128110734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 01/26/2021
Date Signed: 01/26/2021 01:42:01 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
08/19/2020 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200819114439

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: 64	DATE:	01/26/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jenesa McDonald, Activity Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff is not answering facility telephone
Staff is denying visits to residents while in care
Staff is not meeting resident's hygiene needs
Staff is mishandling residents medications
Staff is verbally abusive to residents while in care
Staff is isolating residents while in care

INVESTIGATION FINDINGS:

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On 1/26/21 Licensing Program Analyst (LPA) Shaunte Henry conducted a tele-inspection due to COVID-19 in order to deliver the finding to the above allegations. LPA Henry spoke with Activity Director Jenesa McDonald and explained the purpose of the tele-inspection. The investigation consisted of document review and interviews. The investigation revealed the following for each allegation.

Allegation 1: Staff is not answering the facility telephone
Interviews revealed that during the influx of COVID+ cases, facility staff were required to perform dual duties, which included answering phones and providing care. The administrator communicated this information with the family of Resident 1 (R1). Due to the spike in positive cases at the facility during this particular time, staff provided dual coverage for a short period of time. Staff denies not answering the facility phone, therefore this allegation is unsubstantiated.
***LIC 9099 Page 1 ***

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: 01/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021

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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Control Number 18-AS-20200819114439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARLINGTON RIVERSIDE SENIOR COMMUNITY	FACILITY NUMBER: 331880741
	VISIT DATE: 01/26/2021

NARRATIVE

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Allegation 6: Staff is isolating residents while in care
Due to the COVID-19 pandemic, facilities have the right to isolate residents for containment and mitigation. The facility also maintains the right to isolate residents after returning to the facility after physician visits, emergency room visits and urgent care visits as deemed necessary. Interviews with staff revealed that the facility isolated residents to help prevent the spread of COVID-19, therefore this allegation is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations: 1) Staff is not answering the facility telephone, 2) Staff is denying visits to residents while in care, 3) Staff is not meeting resident's hygiene needs, 4) Staff is mishandling resident's medication, 5) Staff is verbally abusive to residents while in care and 6) Staff is isolating residents while in care are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report and LIC 811 were provided to Activity Director Jenesa McDonald via email and Administrator Gemma Deoso.

***LIC 9099 Page 3***

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 18-AS-20200819114439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARLINGTON RIVERSIDE SENIOR COMMUNITY	FACILITY NUMBER: 331880741
	VISIT DATE: 01/26/2021

NARRATIVE

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***Continued from LIC 9099***
Allegation 2: Staff is denying visits to residents while in care
The investigation revealed that the facility had positive COVID-19 cases in June, July and August 2020. Provider Information Notice (PIN) 20-23 dated 6/26/2020 addressed outlined visitation. In accordance with public health guidance, vitiation by non-essential individuals was limited all of the following conditions were met:
1)There has been no transmission of COVID-19 at the facility for 14 days
2)Facility is not experiencing staff shortages
3)Licensee has adequate supply of PPE and cleaning supplies to care for the persons in care
4)The licensee has adequate access to COVID-19 testing
*A facility may quarantine or cohort residents together as necessary for containment and mitigation only. Therefore, based on the guidelines from PIN 20-23 and interviews conducted, the allegation is unsubstantiated.

Allegation 3: Staff is not meeting resident’s hygiene needs
Documentation review and interviews revealed that R1 received hygiene services. LPA observed hygiene logs, which were signed by staff. LPA reviewed and observed from the log, that R1 did not refuse hygiene services. Based on the LPA's observation and interview, the allegation is unsubstantiated.

Allegation 4: Staff is mishandling resident’s medication
An interview with the administrator, document review of R1's medication administration record (MAR) and LPA's observations revealed that R1 had a medical condition in which medication was prescribed for. Based on LPAs observation of the MAR, R1 received medication as prescribed by the physician. Therefore based on the administrator interview, LPAs observation and documentation review that this allegation is unsubstantiated.

Allegation 5: Staff is verbally abusive to residents while in care
An interview with the administrator and staff revealed that there was no knowledge of verbal abuse towards R1 or any other resident. An interview with R1 and other residents revealed no one experienced verbal abuse from staff. Interviews with staff revealed there was no knowledge of verbal abuse towards R1 or any other resident. Therefore, based on conflicting interviews, this allegation is unsubstantiated.
***LIC 9099 Page 2***

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021

LIC9099 (FAS) - (06/04)

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