331880741-3-24-2023-18-AS-DMUN-CQEMVP-20230330095705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880741
Report Date: 03/23/2023
Date Signed: 03/24/2023 08:24:22 AM

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
03/20/2023 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230320161847

FACILITY NAME:	ARLINGTON RIVERSIDE SENIOR COMMUNITY		FACILITY NUMBER:	331880741
ADMINISTRATOR:	KURT NIEBRES		FACILITY TYPE:	740
ADDRESS:	4609 ARLINGTON AVE		TELEPHONE:	(951) 462-1025
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	150	CENSUS: 73	DATE:	03/23/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Kurt Niebres, Administrator		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Staff failed to assist resident with health conditions leading to hospitalization
Staff are not assisting resident with medical appointments
Staff failed to answer the facility telephone

INVESTIGATION FINDINGS:

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

The LPA conducted staff/resident interviews, reviewed records, and took copies of relevant documentation.

Regarding the allegation, "Staff failed to assist resident with health conditions leading to hospitalization," it was alleged the facility was not assisting Resident One (R1) with two (2) health conditions leading to a hospitalization. Interviews and records reveal R1 does have an existing Restricted Health Condition (RHC) and a condition affecting their lower extremities. Staff interviews revealed R1's RHC has been cared for several times since the resident moved into the facility. Medical records reveal R1 was hospitalized on March 18, 2023 and had their RHC evaluated; however, discharge paperwork did not note concerns relating to the RHC.

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: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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-20230320161847

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: 03/23/2023

NARRATIVE

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In addition, it was alleged staff were not assisting R1 to care for a condition to their lower extremities. Interviews revealed R1 was observed to have a health condition affecting their lower extremities while in care. Interviews revealed the condition to R1's lower extremities was observed to worsen prior to their hospitalization on March 18, 2023. Third party interviews revealed the condition is chronic and treatment includes elevation of the extremities. A record review revealed no documentation was found on file as to how the facility was to care for the condition. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation, "Staff are not assisting resident with medical appointments" it was alleged the facility did not provide transportation for R1 to their medical appointment on March 20, 2023. A review of records was conducted; the admission agreement, which would indicate whether transportation services would be provided, was not completed by the facility. Interviews reported notice to the facility was provided the same day of the appointment. Interviews revealed facility staff did attempt to obtain transportation from a third party for R1, however, the attempt was unsuccessful. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

Pertaining to the allegation, "Staff failed to answer the facility telephone," it was alleged multiple calls were made to the facility pertaining to a resident in care that went unanswered. Dates could not be provided as to when those calls were made. A third-party interview revealed at least one call was made to the facility and the attempt was successful. The LPA made two calls to the facility on March 23, 2023, which went unanswered. Administrator Niebres was interviewed and reported having no knowledge of the issue. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations 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: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC9099 (FAS) - (06/04)

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