336426029-4-19-2023-56-AS-EMAN-CREN2C-20230501100431

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 04/19/2023
Date Signed: 04/19/2023 02:30:51 PM

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
04/13/2023 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230413145230

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: 58	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Licensee/Administrator Amelia Aladin		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff yelled at resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility 04/19/2023 at 01:20 PM to initiate a complaint investigation. LPA Brown was greeted and granted entrance to the facility by a staff and Licensee/Administrator Amelia Aladin met with LPA Brown. LPA Brown explained the purpose of the visit.

The investigation was conducted by LPA Melody Brown. The investigation consisted of observations, records review and interviews with relevant parties. The allegation indicates that Staff yelled at resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with residents and staffs indicated that staffs at the facility do not yell at residents. Residents and staffs’ interviews revealed that no incident happened at the facility that a staff yelled at a resident. Residents reported to LPA Brown that Staff 1 (S1) never yelled at a resident. Staffs reported to LPA Brown that no incident happened at the facility that S1 yelled at a resident.
*** Continuation on 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: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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-20230413145230

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: 04/19/2023

NARRATIVE

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During the visit, LPA Brown observed staffs assisting and communicating/talking to residents in low tone and using respectful words, no staffs are observed yelling at a resident.

Based on the evidence, the allegation that Staff yelled at resident is 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 the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Licensee/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: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

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