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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 03/03/2023
Date Signed: 03/03/2023 12:27:23 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
02/14/2023 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230214082530
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: 59DATE:
03/03/2023
ANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Registered Nurse (RN) Aldrin AladinTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff does not ensure resident attends medical appointments.
INVESTIGATION FINDINGS:
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On 03/03/2023 at 12:15 PM, 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 to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. Below is a summary of the findings of the investigation:

The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The allegation indicates that Staff does not ensure resident attends medical appointments. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with residents indicated that staffs at the facility ensure that they attend their medical appointments. Moreover, interviews with residents revealed that no incident happened at the facility where their medical appointments were cancelled by the facility and they always attend their medical appointments per schedule. *** Continuation in LIC9099C ***
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
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
Control Number 56-AS-20230214082530
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: 03/03/2023
NARRATIVE
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Staffs’ interviews revealed that they are all assisting residents at the facility on their medical appointments and no incident happened where a resident failed to attend the scheduled medical appointments. In addition, staffs’ interviews indicated they never cancel residents medical appointments and no incident happened where a resident failed to attend the scheduled medical appointment. LPA Brown interviewed Resident #1 (R1) and R1 reported to LPA Brown that facility staffs are assisting on R1’s medical appointment and they ensure that R1 attends the scheduled medical appointment. LPA Brown reviewed R1's Medical Appointments Log and it indicated that staffs are assisting residents on R1's medical appointments per schedule.

This agency has investigated the complaint alleging “Staff does not ensure resident attends medical appointments.” 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 MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2