331880741-11-18-2021-18-AS-NBRN-CJYT8N-20221007143035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 11/18/2021
Date Signed: 11/18/2021 07:05:31 PM

Unsubstantiated

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 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2020 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201015152506

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:	DATE:	11/18/2021
		UNANNOUNCED	TIME BEGAN:	05:15 PM
MET WITH:	Jenesa McDonald, Activities Director		TIME COMPLETED:	07:15 PM

ALLEGATION(S):

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Residents medication not administered as prescribed
Staff not maintaining residents hygiene
Staff not following posted menu

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LP) Amy Goldenberg is conducting this unannounced complaint investigation visit to continue inquiry into the allegations noted above. LPA met with Jenessa McDonald and she provided LPA with copies of the record for R1 and copies of facility menus.

LPA learned the following: In regard to residents medication not administered as prescribed, it is alleged that R1 and R2 did not receive their insulin medication timely. R1 and R2 no longer reside at this facility and facility staff do not know where they moved to and were unable to be interviewed prior to their departure. There are no medication records or medications to review. In regard to residents hygiene is not being maintained, it is alleged that R1 and R2 did not receive a bath for a week. LPA reviewed the admission agreement and note that R1 and R2 agreement includes assistance with dressing, toileting, bathing, grooming and mobility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

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-20201015152506

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 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ARLINGTON RIVERSIDE SENIOR COMMUNITY	FACILITY NUMBER: 331880741
	VISIT DATE: 11/18/2021

NARRATIVE

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There are no shower logs produced to the LPA for review and therefore LPA is unable to trace if it was completed or not. In regard to the facility is not following posted menus, it is alleged that the facility ran out of food and the residents were provided cereal to eat. Review of the current menus and review of the food supply are congruent, and it appears that the facility has adequate food resources at this time. However, this does not disprove that the alleged violation didn't happen as reported. Based on the availability of information at this time for the allegations outlined above specific to R1 and R2, we have found the complaint allegation is unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

LIC9099 (FAS) - (06/04)

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