336426029-1-20-2023-56-AS-EMAN-CNEUDC-20230125142917

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 01/20/2023
Date Signed: 01/20/2023 11:55:01 AM

Unfounded

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/11/2022 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220711130532

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: 56	DATE:	01/20/2023
		ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator Amelia Aladin		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident appeared to be unkempt while in care.
Facility did not ensure that resident was adequately hydrated while in care.
Facility did not seek resident medical attention while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Melody Brown and Magda Malcore met with Administrator Amelia Aladin at Riverside and San Bernardino Regional Office – Community Care Licensing Division 01/20/2023 at 10:30 AM to deliver the findings on the open complaint with the allegations above. LPAs Brown and Malcore advised Administrator Aladin of the purpose of today's In-Office Visit. Below is a summary of the findings of the investigation:

Regarding allegation Resident appeared to be unkempt while in care, LPA Brown reviewed Resident #1 (R1) documents and conducted interviews with relevant parties. Staff interviews indicated they are assisting residents on their daily hygiene and grooming that all residents were taken care of. Residents interviews indicated staff are taking care of them and staff always make sure that they are assisting them with their shower, and other daily hygiene and grooming needs. LPA Brown reviewed documents and it indicated R1 was assisted with scheduled showers, other daily hygiene activities and grooming.
*** Continuation in LIC9099C ***

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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-20220711130532

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
, CA 92507

FACILITY NAME: CALOAKS SENIOR LIVING	FACILITY NUMBER: 336426029
	VISIT DATE: 01/20/2023

NARRATIVE

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In addition, during the facility visit last 07/14/2022, LPA Brown observed R1 neat in appearance, hair neatly comb, wearing clean clothes and comfortable shoes.

Regarding allegation Facility did not ensure that resident was adequately hydrated while in care, LPA Brown reviewed documents and conducted interviews with relevant parties. Staffs interviews indicated that they all checked on all residents every one (1) to two (2) hours to ensure that they are adequately hydrated. Residents interviews indicated that staff are checking on them and constantly reminding them to always be hydrated and if needed, staffs are assisting them on getting their water or juice in their room. During the visit last 07/14/2022, LPA Brown observed a pitcher of water available in R1's room and also observed two (2) water and juice carts located near the activity area and in front and Administrator Aladin reported that water and juice carts were made available 24 hours for their residents in care.

Regarding allegation Facility did not seek resident medical attention while in care, LPA Brown reviewed Resident #1 (R1) documents and conducted interviews with relevant parties. Staff interviews indicated that they are all assisting residents if they needed help, and if a resident needed medical attention, they make sure that they are assisting and providing the needed medical attention for the resident. Staff interviews also revealed that any observed changes of condition of a resident is being reported to the residents' physician. Residents interviews indicated all staff are assisting them if they need help and if they need medical attention, staffs will report to their physician for them to get the medical attention they need. LPA Brown reviewed documents and LPA Brown observed that R1 had regular visits and consultation with R1's Physician.

This agency has investigated the complaint allegations. 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. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator Amelia Aladin and a copy of this report (LIC9099) was discussed and provided.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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