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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 07/10/2020
Date Signed: 07/13/2020 03:35:07 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
01/28/2020 and conducted by Evaluator Naisha Kendrix
COMPLAINT CONTROL NUMBER: 18-AS-20200128093414
FACILITY NAME:CALOAKS SENIOR LIVINGFACILITY NUMBER:
336426029
ADMINISTRATOR:AMELIA ALADINFACILITY TYPE:
740
ADDRESS:3891 POLK STREETTELEPHONE:
(951) 689-6162
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:74CENSUS: 68DATE:
07/10/2020
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Amelia, AladinTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are overmedicating resident.
Staff threaten residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Due to the Department’s implementation, and in following current public health guidance, this report will be delivered via tele-visit. Licensing Program Analyst (LPA) Naisha Kendrix identified herself to the administrator, Amelia Aladin, and stated the reason for the tele-visit was to deliver the findings for the above allegations.

During the investigation, LPA conducted nine interviews and found that resident one (R1) claims they were provided too much medication by staff. LPA was informed that R1 had an infection that reacted with the medication they were taking causing them to feel overmedicated. R1 was treated for the infection and the medication was discontinued. All of the interviews conducted could not corroborate the allegation of staff threatens residents. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted via phone where this report was reviewed and provided to the Administrator, Amelia Aladin via email. The Administrator will review and return the signed reports within 24 hours of receipt.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Edna MusokeTELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Naisha KendrixTELEPHONE: (951) 204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2020
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 2
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
01/28/2020 and conducted by Evaluator Naisha Kendrix
COMPLAINT CONTROL NUMBER: 18-AS-20200128093414

FACILITY NAME:CALOAKS SENIOR LIVINGFACILITY NUMBER:
336426029
ADMINISTRATOR:AMELIA ALADINFACILITY TYPE:
740
ADDRESS:3891 POLK STREETTELEPHONE:
(951) 689-6162
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:74CENSUS: 68DATE:
07/10/2020
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Amelia AladinTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is not being bathed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Due to the Department’s implementation, and in following current public health guidance, this report will be delivered via tele-visit. Licensing Program Analyst (LPA) Naisha Kendrix identified herself to the administrator, Amelia Aladin, and stated the reason for the tele-visit was to deliver the finding for the above allegation.

Interviews conducted and records reviewed indicate due to R1’s medical condition they were prescribed bed baths by a physician as of 4/28/2019. The facility is providing the bed baths per the physician prescriptions and has documented times they were given. LPA conducted an interview confirming R1 is still prescribed bed baths as of 7/8/2020. This agency has investigated the complaint alleging the resident is not being bathed. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted via phone where this report was reviewed and provided to the Administrator, Amelia Aladin via email. The Administrator will review and return the signed reports within 24 hours of receipt.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Edna MusokeTELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Naisha KendrixTELEPHONE: (951) 204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2020
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 2