336426029-10-30-2020-18-AS-EMAN-BV3UBQ-20201105142644

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 10/30/2020
Date Signed: 10/30/2020 12:56:45 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
06/17/2020 and conducted by Evaluator Robbie Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200617103747

FACILITY NAME:	CALOAKS SENIOR LIVING		FACILITY NUMBER:	336426029
ADMINISTRATOR:	AMELIA ALADIN		FACILITY TYPE:	740
ADDRESS:	3891 POLK STREET		TELEPHONE:	(951) 689-6162
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92505
CAPACITY:	74	CENSUS: 60	DATE:	10/30/2020
		UNANNOUNCED	TIME BEGAN:	02:07 PM
MET WITH:	Amy Aladin, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff did not notice a change in the resident's condition
Facility staff did not seek medical attention for resident
Facility staff did not safeguard resident's property
Facility staff are not dispensing medications as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Robbie Johnson contacted the facility via telephone to deliver findings via telephone due to COVID-19. LPA identified herself and discussed the purpose of the call and the elements of the above allegation with Administrator Amelia "Amy" Aladin.

The Department conducted investigation of allegation to include interviews and records review. Allegation #1 interviews with staff revealed that when resident R1 made a complaint of pain, staff assessed R1 then scheduled R1 for a televisit with a physician. A review of the facility records revealed that R1 had several telehealth visit appointments with physicians in which R1 was prescribed additional medication. LPA could find no evidence to support that staff did not assess the residents condition and provide access to medical doctors. The allegation is UNSUBSTANTIATED. Allegation #2 A review of the facility records revealed that R1 had several tele health visits with medical professionals. LPA could not corroborate that facility staff did not seek medical attention for R1. The allegation is UNSUBSTANTIATED. Allegation # 3 Interviews with staff revealed that no resident has complained about property being lost or stolen. Interviews with residents revealed that they have not had any of their personal belongings lost or stolen. LPA could find no evidence that the facility failed to safeguard residents property. The allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Robbie Johnson	TELEPHONE: (951) 248-0304
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020

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 18-AS-20200617103747

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CALOAKS SENIOR LIVING	FACILITY NUMBER: 336426029
	VISIT DATE: 10/30/2020

NARRATIVE

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Allegation #4 LPA reviewed physicians orders and the Medication and Administration records for R1. Based a review of records it appears that the facility is administering medications per physicians orders. LPA could find no evidence to support that the facility staff is not administering medication as prescribed. The allegation 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 abuse occurred. A copy of this report was reviewed with and provided to the Administrator via email.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Robbie Johnson	TELEPHONE: (951) 248-0304
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020

LIC9099 (FAS) - (06/04)

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