331880741-4-20-2022-18-AS-NBRN-CP3QKZ-20230215111510

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 04/20/2022
Date Signed: 04/20/2022 07:14:26 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
06/30/2021 and conducted by Evaluator Amy Goldenberg

COMPLAINT CONTROL NUMBER: 18-AS-20210630131507

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:	04/20/2022
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Kurt Niebres, Administrator		TIME COMPLETED:	07:30 PM

ALLEGATION(S):

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-Staff does not ensure resident's are fed.
-Inadequate staffing resulting in resident's needs not being met.
-Resident's are not provided nutritious meals.

INVESTIGATION FINDINGS:

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This unannounced visit conducted by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegations mentioned above.

During the course of this investigation LPA interviewed nine (9) residents, assessed the food supply, and reviewed menus and staffing schedules. LPA learned the following information: Regarding the allegation that staff does not ensure residents are being fed, nine (9) of nine (9) residents interviewed did not state that they do not receive meals or snacks. In regard to inadequate staffing five (5) of nine (9) residents interviewed stated that their needs are met and that staffing is adequate. Four (4) of nine (9) residents interviewed revealed that there is not enough staff, but have not stated that staff do not arrive to assist them, although sometimes delayed, their needs are being met.

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: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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-20210630131507

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: 04/20/2022

NARRATIVE

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In regard to residents are not receiving nutritious meals, review of the facility menus and assessment of the food supply at this time are adequate to meet the requirement for nutrition. The facility receives their menus through an outside vendor. Four (4) out of nine (9) residents interviewed stated that the food is good and that they have no issues. Five (5) of nine (9) residents interviewed complained that they do not like the food, but receive enough to eat. Overall there were no complaints regarding alternatives and meal variety.

Based on the available information at this time, we have found the complaint allegations are unsubstantiated. Although the allegation 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: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC9099 (FAS) - (06/04)

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