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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880774
Report Date: 05/08/2025
Date Signed: 05/08/2025 03:11:06 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
03/17/2022 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220317170451
FACILITY NAME:RAINCROSS AT RIVERSIDEFACILITY NUMBER:
331880774
ADMINISTRATOR:JUDITH PIERFAXFACILITY TYPE:
740
ADDRESS:5232 CENTRAL AVENUETELEPHONE:
(951) 785-1200
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:120CENSUS: 70DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Executive Director, Mary McClureTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Resident was not provided a copy of the Admissions Agreement.
Resident's charges were increased without proper notice.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Executive Director, Mary McClure who was informed of the purpose of the visit. LPA conducted interviews and conducted records review.

It was alleged “Resident was not provided a copy of the Admissions Agreement.” It was alleged Resident #1 (R1) and their legal representative did not receive a copy of the facility’s new admission agreement. Interview with R1 was unable to be conducted as they have passed away. Interview with R1’s legal representative was attempted but unable to be conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
03/17/2022 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220317170451

FACILITY NAME:RAINCROSS AT RIVERSIDEFACILITY NUMBER:
331880774
ADMINISTRATOR:JUDITH PIERFAXFACILITY TYPE:
740
ADDRESS:5232 CENTRAL AVENUETELEPHONE:
(951) 785-1200
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:120CENSUS: 70DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Executive Director, Mary McClureTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Resident is being charged for services not provided.
Resident is being overcharged for services.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Executive Director, Mary McClure who was informed of the purpose of the visit. During the visit, LPA conducted interviews and conducted records review.

It was alleged that “Resident is being overcharged for services.” It was alleged R1 was being excessively charged for required services such as medication administration, transferring, bathing, and grooming at a rate of $11,141.97 March of 2022. Interview with R1 was unable to be conducted as they have passed away. Interview with R1’s legal representative was attempted but unable to be conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20220317170451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RAINCROSS AT RIVERSIDE
FACILITY NUMBER: 331880774
VISIT DATE: 05/08/2025
NARRATIVE
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 Interview with (1) administrative staff revealed March of 2022 the facility was using a new fee structure where points were being allocated based on resident’s needs. R1’s Resident Ledger report revealed R1 was billed and rated at 13,692 care points March of 2022. Records review revealed R1 did not have a care points assessment for services rendered. Therefore, the allegation that R1 was being overcharged for services is unsubstantiated at this time.

It was alleged “Resident is being charged for services not provided.” It was alleged R1 was being charged for services such as bathing, grooming, and transferring and were not being provided to R1. It was alleged R1’s hospice agency was providing bathes and facility staff would not transfer R1 out of bed. It was also alleged that R1 was being charged $35.00 for Cable television when R1 did not have a television. Interview with R1 was unable to be conducted as they have passed away. Interview with R1’s legal representative was attempted but unable to be conducted.

R1’s Resident Ledger report and move in billing ledger revealed R1 was being charged for Cable television since admission in 2017. R1’s care plan dated 03/03/2022 revealed R1 required a (2) person assist for transfers, required assistance with dressing and grooming, and bathing services were being provided by an outside hospice provider.

LPA conducted interviews with (4) staff who provided care to R1. (2) of (4) staff interviewed did not recall services provided to R1. (1) of (4) staff revealed R1 was transferred out of bed, while (1) of (4) staff revealed R1 was contracted and staff was unable to move R1 out of bed and would have been reflected in their care points assessment. No documentation for R1's care points assessment was found in R1's file. (2) of (4) staff revealed R1 was assisted with grooming, hygiene, and bathing as needed with R1's hospice agency providing most of the bathing. (4) of (4) Staff did not recall if R1 had a television in their room or was billed for cable television.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 18-AS-20220317170451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RAINCROSS AT RIVERSIDE
FACILITY NUMBER: 331880774
VISIT DATE: 05/08/2025
NARRATIVE
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Therefore, based on interviews and records review the allegation that R1 was being charged for services not rendered is unsubstantiated at this time.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20220317170451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RAINCROSS AT RIVERSIDE
FACILITY NUMBER: 331880774
VISIT DATE: 05/08/2025
NARRATIVE
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On 03/22/2022 Department staff interviewed (1) administrative staff which revealed R1 and their representative did not sign the new revised admission agreement. Records review revealed the admission agreement for the facility had changed March of 2021 and the last admission agreement for R1 was signed in 2017. Therefore, the allegation that the R1 and their legal representative did not receive a copy of the new admission agreement is substantiated. This deficiency was cited for R1 on case management visit on 03/22/2022. Therefore, the facility was not recited on this report.

It was alleged “Resident's charges were increased without proper notice.” It was alleged the facility changed their fee structure for services rendered from $6,085.00 to $11,141.97 for R1 March of 2022. It was alleged R1 and their legal representative were not informed of the fee changes. Interview with R1 was unable to be conducted as they have passed away. Interview with R1’s legal representative was attempted but unable to be conducted.

Interview with (1) administrative staff revealed all residents including R1 were informed of the fee structure changes in a letter. Letter dated 03/01/2021 revealed residents were informed that the new fee structure would go into effect on the same day and could be referenced in the new residency agreement. Based on the substantiated allegation above, R1 did not sign a revised admission agreement with the new fee structure. Additionally, Health and Safety Code section 1569.655 states residents shall receive written notice no less than 60 days’ prior to increase of fees and must include the reason for the increase and the amount of the increase. No documentation of proper written notice was found in R1’s file.

Therefore, based on interview and record review the preponderance of evidence standard has been met and .the allegation is substantiated. California Code of Regulations Title 22, is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20220317170451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RAINCROSS AT RIVERSIDE
FACILITY NUMBER: 331880774
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2025
Section Cited
HSC
1569.655(a)
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(a) If a licensee…increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs…
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The administrator provided proof of written communication sent to residents informing them of fee increases consistent with the section cited here. Deficency was cleared at the time of the visit.
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This requirement was not met as evidenced by: Based on interview and record review the facility did not issue proper notice to R1 and their representative of increase in fees. This poses a potential health saftey or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6