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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881480
Report Date: 08/18/2025
Date Signed: 08/19/2025 08:09:22 AM

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
04/19/2024 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20240419162313
FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331881480
ADMINISTRATOR:WILLIAMS, MORGANFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:232CENSUS: 97DATE:
08/18/2025
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Administrator Mollie BowieTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff does not ensure resident is administered medications as prescribed
Staff is mismanaging resident's medications
INVESTIGATION FINDINGS:
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On 8/18/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering investigative findings into the allegations listed above. LPA Flores identified herself and discussed the purpose of the visit with Administrator, Mollie Bowie. A tour of the facility was conducted and LPA did not observe any health and safety concerns. The investigation consisted of record reviews and interviews.

It was alleged staff did not ensure residents were administered medication as prescribed. On the afternoon of 3/18/2024, Staff #1 (S1) documented on the Medication Administration Record (MAR) that Resident #2 (R2) was out of a medication and was needing to be filled. Per the MAR, R2 did not receive the refilled medication until 3/21/2024. Through interviews, information obtained alleged staff are waiting until the medication was out-of-stock until a new order of the medication is submitted causing there to be a delay of when the residents were receiving their medication.
(Continuation to LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
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 5
Control Number 18-AS-20240419162313
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: ARLINGTON RIVERSIDE SENIOR COMMUNITY
FACILITY NUMBER: 331881480
VISIT DATE: 08/18/2025
NARRATIVE
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(Continuation from LIC9099)

Information received by the pharmacy further corroborated that staff did not place the initial order to fill prior to the medication running out on 3/18/2024. An order to fill was received on 3/20/2024 and medication was refilled/delivered on 3/21/2024. Therefore, the order delay resulted in medication being inaccessible to R2 if and when it was needed.

It was further alleged that staff is mismanaging residents’ medication. Through record review, the MAR divulged R2’s medication was “not in cart” on 3/18/2024. Interviews confirmed when staff document that medication is “not in cart”, it means resident finished the medication and a new order is needing to be placed. On the afternoon of 3/19/2024, S1 documented R2 refused the medication. On the morning of 3/20/2024, Staff #2 (S2) documented on the MAR that the medication was “not in cart will follow up”. The afternoon of 3/20/2024, S1 documented on the MAR that R2 was administered the medication. Verbal information received by the pharmacy confirmed that the medication order was placed on 3/20/2024 and filled on 3/21/2024. The previous order for that medication was placed in February of 2024. Therefore, the facility staff did not have medication to offer or provide to R2 as it was previously alleged by S1 on the listed dates.

Based on interviews and records review, the allegations of staff do not ensure resident is administered medications as prescribed, and staff is mismanaging resident's medications has been determined to be SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations (Title 22, Division 6 & Chapter 3) are being cited on the attached LIC 9099D).
An exit interview was conducted and a copy of this report, 9099D, appeal rights, and LIC811-confidential names list were reviewed and provided to Administrator, Mollie Bowie.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20240419162313
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: ARLINGTON RIVERSIDE SENIOR COMMUNITY
FACILITY NUMBER: 331881480
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2025
Section Cited
CCR
87465(c)(2)
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Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly...if the following requirements are met: (2) once ordered by
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The Licensee agrees to in-service training on medication administration and timely reordering to delay lapse in medication. This training is to be forwarded to LPA via email by close of business on 9/5/2025.
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 the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:1 out of 1 residents was out of their prescribed medication for multiple days. This poses a potential health, safety and personal rights risk to persons in care
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Type B
09/05/2025
Section Cited
CCR
87465(a)(1)
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Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall... provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange...for medical and dental care appropriate to the conditions and needs of residents. This was not met by:
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The Licensee agrees to in-service on proper documentation when completeing the Medication administration record, This training is to be forwarded to LPA via email by close of business on 9/5/2025.
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The Licensee did not comply with the above regulation with 1 out of 1 residents. As R2 was not given their medication as prescribed on multiple occassions. This is an immedaite health, safety and personal rights risk to persons 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: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
04/19/2024 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20240419162313

FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331881480
ADMINISTRATOR:WILLIAMS, MORGANFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:232CENSUS: DATE:
08/18/2025
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Administrator Mollie BowieTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
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5
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9
Staff changed resident's pharmacy without resident's consent
INVESTIGATION FINDINGS:
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10
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13
On 8/18/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering investigative findings into the allegations listed above. LPA Flores identified herself and discussed the purpose of the visit with Administrator, Mollie Bowie. A tour of the facility was conducted, and LPA did not observe any health and safety concerns. The investigation consisted of record reviews and interviews.
Information received alleged staff changed resident’s pharmacy without resident’s consent. An interview conducted with Administrator Molly Bowie, revealed that upon admission staff advise residents the facility is contracted with Market Pharmacy. Market Pharmacy provides delivery services to the facility allowing residents to receive the medication without having residents retrieve the medication themselves. It was report that most residents opt in for Market Pharmacy as it is more convenient for the residents.

(Continue to LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20240419162313
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: ARLINGTON RIVERSIDE SENIOR COMMUNITY
FACILITY NUMBER: 331881480
VISIT DATE: 08/18/2025
NARRATIVE
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(Continuation from LIC9099A)

The facility does not retain records of residents enlisting and/or changing their pharmacy as it is the decision of the resident and the resident’s responsible party.
Per Mollie, the resident and their responsible party are the only people allowed to enroll and/or make changes to the residents pharmacy. If a resident chose to enroll in Market Pharmacy, the resident would have to contact Market Pharmacy directly to enroll. A review of R1’s file was conducted, and it did not contain any documents related to which pharmacy R1 is utilizing. Additional interviews conducted with a relevant party, corroborated that R1 is the only person able to change the pharmacy and changes can be conducted over the phone
Based on interviews and records review, the allegation of staff changed resident's pharmacy without resident's consent is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.
An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator, Mollie Bowie.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5