336426029-11-9-2022-56-AS-EMAN-CLNQEN-20221130110636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 11/09/2022
Date Signed: 11/09/2022 03:24:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/04/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221104154921

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: 61	DATE:	11/09/2022
		UNANNOUNCED	TIME BEGAN:	12:41 PM
MET WITH:	Melissa Bridges- Wellness Director/Manager		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff failed to seek medical attention for resident in a timely manner.
Staff failed to meet resident's hygiene needs.
Facility is unclean.
Staff is not assisting resident with feedings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner arrived at the facility unannounced to initiate and deliver findings for the above complaint allegations. LPA met with Wellness Director/Manager Melissa Bridges and explained the reason for the visit.

During today’s visit, LPA conducted interviews with residents and staff and was provided medical/facility documents for Resident R1 and Resident R2.

For allegation, Staff failed to seek medical attention for resident in a timely manner:

LPA interviewed staff and resident R1. During interviews conducted with R1 and staff, R1 and staff stated that the facility is taking care of R1’s medical needs in a timely manner. LPA reviewed R1’s documents and found that R1 was in the hospital from 7/28/2022 to 9/1/2022. On 9/8/2022, R1 had a medical concern, the facility contacted R1’s primary doctor and R1 was prescribed a medication.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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-20221104154921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CALOAKS SENIOR LIVING	FACILITY NUMBER: 336426029
	VISIT DATE: 11/09/2022

NARRATIVE

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On 9/12/2022, the facility contacted R1’s primary doctor to get an additional medication due to the first medication not resolving the symptoms. Due to the ongoing issue, the facility contacted a specialist doctor and setup an appointment for 9/29/2022. The appointment scheduled on 9/29/2022 was canceled and rescheduled to 10/13/2022 due to R1’s medical insurance and R1 needing a specific type of medical transport. R1's responsible party was contacted and informed of the appointment delay. On 10/4/2022, the facility contacted R1’s primary doctor and R1 was prescribed an additional medication. On 10/13/2022, R1 completed the appointment with the specialist doctor and was prescribed medication to treat R1’s symptoms. R1 currently takes a medication twice a day to treat the symptoms. Staff and R1 stated that R1's medication is being used as directed by the doctor. R1 stated that they are healing, not in pain, and there are no complaints on how the facility is treating R1’s medical needs. LPA found that the facility took the correct steps and had documentation for R1’s progress. LPA was not given information to collaborate the allegation.

For allegation, Staff failed to meet resident's hygiene needs:

LPA was given a copy of R1’s shower schedule that shows R1 is showered twice a week. LPA conducted interviews with staff and R1, during interviews conducted LPA was informed that R1 is showered every Monday and Friday. LPA was informed that R1 has sponge baths in between shower days and is showered more often if needed. LPA was informed the resident's bedding is changed every two (2) to three (3) days. R1 stated the staff does a good job with their hygiene. LPA was not given information to collaborate the allegation.

For allegation, Facility is unclean:

LPA conducted interviews with staff and residents, LPA found that the resident’s bedrooms and bathrooms are cleaned daily. The residents bedding is changed twice a week and will be changed more often if needed. LPA observed the resident’s bathrooms and bedrooms to be clean and free of odor. LPA was not given information to collaborate the allegation.

For allegation, Staff is not assisting resident with feedings:

LPA was given a copy of R2's physician's report that shows R2 is on a special diet and receives feeding assistance. LPA interviewed R2 and staff and found that the staff are assisting R2 with feedings.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20221104154921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CALOAKS SENIOR LIVING	FACILITY NUMBER: 336426029
	VISIT DATE: 11/09/2022

NARRATIVE

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R2 stated they are never left on their own to eat and assistance by staff is always given during feeding times. LPA was not given information to collaborate the allegation.

Based on information found and discovered, LPA found that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the four (4) allegations listed above are deemed UNSUBSTANTIATED.

An exit interview was conducted, and this report was discussed and provided to Wellness Director/Manager Melissa Bridges, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

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