331880774-7-22-2021-18-AS-EMAN-C5BQF6-20210727120721

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880774
Report Date: 07/20/2021
Date Signed: 07/22/2021 03:41:14 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 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2020 and conducted by Evaluator Elecia Weathersby

COMPLAINT CONTROL NUMBER: 18-AS-20200513091353

FACILITY NAME:	RAINCROSS AT RIVERSIDE		FACILITY NUMBER:	331880774
ADMINISTRATOR:	BROWN, TERRY		FACILITY TYPE:	740
ADDRESS:	5232 CENTRAL AVENUE		TELEPHONE:	(951) 785-1200
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	120	CENSUS: 78	DATE:	07/20/2021
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Administrator, Judith Pierfax		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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(1) Facility staff failed to provide resident's records to resident's authorized representative.
(2) Facility did not provide adequate supervision resulting in resident falling.

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA's) Elecia Weathersby and Melody Brown conducted an unannounced facility visit to deliver the finding on the above allegation(s). LPA's spoke with Administrator Judith Pierfax.

This agency has investigated the following complaint(s) alleging:

Allegation #(1) Facility staff failed to provide resident's records to resident's authorized representative.
The Reporting Party confirmed that the requested records were provided since the filing the complaint. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Allegation #(2) Facility did not provide adequate supervision resulting in resident falling.
R1 was never a resident of the current facility due to a change of ownership. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Administrator, Judith Pierfax where this report, LIC 9099 were discussed and provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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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