336426029-2-10-2023-56-AS-EMAN-CP9P3A-20230221095712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:47:16 PM

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
01/25/2023 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230125141746

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:	02/10/2023
		ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Registered Nurse Aldrin Aladin		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff yelled at resident.
Facility overcharged resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown met with Registered Nurse (RN) Aldrin Aladin at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 02/10/2023 at 01:30 PM to deliver the findings of the above allegations. LPA Brown explained the purpose of the requested Office Visit. Below is a summary of the findings of the investigation:

Regarding allegation “Staff yelled at resident, “LPA Brown reviewed Resident #1 (R1) documents and conducted interviews with relevant parties. Staff interviews indicated that they never yelled at residents or witnessed an incident where a staff yelled at a resident. Staff interviews indicated that they all speak to their residents with respect. In addition, staffs reported that they did not witness Staff #1 (S1) yelled at a resident.

*** 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: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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-20230125141746

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: 02/10/2023

NARRATIVE

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Residents’ interviews indicated that staff never yelled at them, and they did not witness an incident at the facility where a staff yelled at a resident. Moreover, interview with residents revealed that they did not witness S1 yelling at a resident. Residents’ interviews revealed that all staff are kind and always ready to help the residents in care. In addition, during the facility visit last 01/27/2023, LPA Brown observed staffs and S1 talking to residents kindly and with respect. LPA Brown did not witness any staff or S1 yelling at R1 or other residents.

Regarding allegation “Facility overcharged resident”, LPA Brown reviewed documents and conducted interviews with relevant parties. Staffs’ interviews indicated that they are aware and informed last 01/2023 of the intended increase in the facility rate due to the recent increase in Supplementary Security Income/State Supplementary Payment (SSI). Staff #1 (S1) reported to LPA Brown during the facility visit last 01/27/2023 that all residents are informed of the facility rate increase last 01/2023 due to the recent increase in SSI payments effective 01/2023. S1 added that they are only charging their residents with what’s allowed facility rate for basic services by the state, and the facility are not charging their residents or R1 more than the SSI facility rate for basic services that the state allowed. LPA Brown interviewed R1, and it revealed that R1 misunderstood the information provided by the facility of the intended facility rate increase due to recent increased in SSI payments last 01/2023 and R1’s not aware that the facility’s charging only the allowed facility rate for basic services by the state and that the facility cannot charged more than what’s allowed by the state for facility rate for basic services.

This agency has investigated the complaint alleging “Staff yelled at resident (Allegation #1)”, and “Facility overcharged resident (Allegation #2).” We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with RN Aldrin 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: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

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