331880741-12-14-2022-18-AS-DMUN-CMHRD3-20221227115513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 12/14/2022
Date Signed: 12/14/2022 01:17:08 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
10/27/2021 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211027100438

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: 75	DATE:	12/14/2022
		UNANNOUNCED	TIME BEGAN:	08:18 AM
MET WITH:	Kurt Niebres, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Licensee does not have sufficient resources to meet operating costs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegation. The LPA met with Kurt Niebres, Administrator, and informed him of the purpose of the visit.

During the investigation the LPA conducted staff interviews, reviewed records and took copies of pertinent documentation. Pertaining to the allegation, "Licensee does not have sufficient resources to meet operating costs," it was alleged the Licensee filed for bankruptcy and did not report it to the appropriate agencies. Licensee, Kevin Long Ha, was interviewed and reported one of the managing members of the facility had filed for bankruptcy, however, the bankruptcy has not affected the operation of the facility. Staff interviews reported equipment and/or materials needed to provide care to residents was low, had run out, or had not been followed up on by management. Interviews and observation revealed utilities were all available and operable. In addition, the LPA observed a third party vendor report they had not been paid for several months and requested follow-up

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

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-20211027100438

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: 12/14/2022

NARRATIVE

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from the facility staff designated to corresponde with the vendor. Interviews could not provide information on whether the concerns reported were due to insufficient resources. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding 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 the alleged violation occurred.

This report was reviewed with Niebres and a copy was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

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