335530134-1-28-2026-56-AS-EMAN-DRGNPQ-20260220093843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530134
Report Date: 01/28/2026
Date Signed: 01/28/2026 11:59:33 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
01/23/2026 and conducted by Evaluator Beena Singh

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20260123094442

FACILITY NAME:	GARDENS OF RIVERSIDE, THE		FACILITY NUMBER:	335530134
ADMINISTRATOR:	GARCIA, GRISELDA "GRACIE".		FACILITY TYPE:	740
ADDRESS:	10849 ARLINGTON AVENUE		TELEPHONE:	(951) 637-8844
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92505
CAPACITY:	98	CENSUS: 86	DATE:	01/28/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Facility Administrator Griselda Gracie Garcia		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff refused to accept resident back from hospital.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to initiate and deliver findings on a complaint alleging Staff refused to accept resident back from hospital.

LPA Singh met with Facility Administrator Griselda Gracie Garcia, facility representative and was informed of the visit, the investigation conducted by LPA Singh consisted of interviews and records review.

Allegation:-Staff refused to accept resident back from hospital.

LPA Singh interviewed and reviewed records staff and residents; four(4) out of four (4) staff present on the day at the incident reported that R#1 has exhibited behavioral episodes over the past few months. On January 22, 2026, R#1 was observed swinging a walker at other residents, attacking staff, and attempting to leave the facility. Staff reported that Community Care Licensing Department(CCLD) had been notified of

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026

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 56-AS-20260123094442

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GARDENS OF RIVERSIDE, THE	FACILITY NUMBER: 335530134
	VISIT DATE: 01/28/2026

NARRATIVE

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R#1’s ongoing behaviors, and the family had been informed. R#1 was evaluated by InnovAge physicians, and medications were adjusted; however, the Power of Attorney(POA) later discontinued the medication, which resulted in an increase in R#1s behavioral issues.

The facility administrator stated that the facility is not evicting R#1. R#1 was sent to the hospital for a health evaluation and change of condition due to 5150 call to the emergency services, and once medication is initiated and behavioral symptoms stabilize, R#1 may return to the facility. The facility informed R#1’s family and InnovAge of the change in condition and the need for hospital evaluation due to safety of the staff and residents at the facility. Statements, records, and interviews obtained did not provide sufficient information to corroborate the allegation that Staff refused to accept resident back from hospital.

Based on the evidence found during the investigation, the allegations, Staff refused to accept resident back from hospital, listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809) LIC 809C were discussed and provided to Facility Administrator Griselda Gracie Garcia.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026

LIC9099 (FAS) - (06/04)

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