331880838-2-28-2023-56-AS-KCLS-CQCUNE-20230328154343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880838
Report Date: 02/28/2023
Date Signed: 02/28/2023 02:15:09 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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2023 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230223165108

FACILITY NAME:	EMK RESIDENTIAL CARE FOR ELDERLY		FACILITY NUMBER:	331880838
ADMINISTRATOR:	PANALIGAN, MARILOU		FACILITY TYPE:	740
ADDRESS:	7750 BOLERO DRIVE		TELEPHONE:	(951) 332-0558
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	6	CENSUS: 6	DATE:	02/28/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Marineth and Henry Reyes, Staff		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Facility is over capacity.
Facility serving food not of good quality.
Facility does not maintain sufficient food and supplies for residents in care
Facility retaining resident's with prohibited health conditions.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to initiate a complaint investigation regarding the above-mentioned allegations. LPA met with staff Marineth Reyes and Henry Reyes who provide LPA with resident files (R1, R2, R3, R4, R5, R6). Review of resident records does not reveal any resident with a prohibited health condition. LPA met and observed all residents at time of visit. LPA observed the food supply and observed a sufficient supplies of perishables and non perishables with food being served of good quality and ample servings.

Based on the information obtained there is not enough evidence that the facility is over capacity, facility is serving food not of good quality and the facility does not maintain sufficient food and supplies for residents and facility retaining resident's with prohibited health conditions. Therefore, the allegations that is deemed UNSUBSTANTIATED at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

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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