336426029-1-31-2023-56-AS-EMAN-CNLUJV-20230131143809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 01/31/2023
Date Signed: 01/31/2023 09:02:02 AM

Unsubstantiated

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
07/29/2022 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220729171929

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: 54	DATE:	01/31/2023
		ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Administrator Amelia Aladin		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff does not prevent resident from wandering away from the facility
Staff does not ensure that resident takes medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown met with Administrator Amelia Aladin at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 01/30/2023 at 08:30 AM to deliver the findings of the above allegations. LPA Brown explained the purpose of the requested Office Visit.

The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The first allegation indicates that due to neglect/lack of supervision, Staff does not prevent Resident 1 (R1) from wandering away from the facility. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Records review and interviews with staffs and residents indicated that staffs regularly check and monitors all residents at least every two (2) hours or more if needed.
*** Continuation in LIC9099C ***

Unsubstantiated

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: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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-20220729171929

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: 01/31/2023

NARRATIVE

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In addition, staff interviews revealed that during the incident last 07/24/2022, Staff 2 (S2) was assigned to monitor the facility gate camera that day and saw R1 rushed out of the facility gate when paramedics arrived at the facility and staff immediately looked for R1 and incident was immediately reported to law enforcement, responsible party and other government agencies. Interviews with the law enforcement staff indicated that they found R1 that same day R1 rushed out of the facility gate. Responsible party also confirmed with LPA Brown that R1 was found the same day R1 rushed out/stormed out of the facility gate.

The second allegation indicates that Staff does not ensure that resident takes medication as prescribed. During the investigation, LPA Brown did not find evidence to corroborate the allegation. The investigation consisted of records review and interviews with relevant parties. Staffs reported that all client medications are centrally stored and administered according to their physician’s orders. Residents interviews indicated that staffs ensure that they take their medications as prescribed. During the facility visit last 01/27/2023, LPA Brown observed medication records existed for R1. Administrator Aladin provided R1's Medication Administration Record (MAR) that showed R1’s medications were dispensed as prescribed by R1’s physician and also showed that staffs ensured resident takes medication as prescribed.

Based on the evidence, the allegation that Staff does not prevent resident from wandering away from the facility (allegation #1) and Staff does not ensure that resident takes medication as prescribed (allegation # 2) are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegations are unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Administrator Amelia Aladin.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

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