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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 07/21/2025
Date Signed: 07/21/2025 11:50:52 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250715102850
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: 51DATE:
07/21/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee/Administrator Amelia AladinTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff are not properly addressing roaches in the facility.
Staff are not preventing residents from smoking inside of the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Facility Resident care director Melissa Bridges and explained the purpose of the visit, Licensee/Administrator Amelia Aladin arrived during the visit. The investigation consisted of staff interviews, resident interviews, and facility tour.

For the allegation, Staff are not properly addressing roaches in the facility.

During staff interviews, 5 out of the 5 staff stated they have not seen pest inside the facility. During resident interviews 10 out of the 10 resident stated they have not seen any roaches inside their room or in facility area.

During document review, LPA observed the facility receives pest control maintenance once a month.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
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-20250715102850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CALOAKS SENIOR LIVING
FACILITY NUMBER: 336426029
VISIT DATE: 07/21/2025
NARRATIVE
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For the second allegation, Staff are not preventing residents from smoking inside of the facility.

During staff interviews, 5 out of the 5 staff stated residents are not allowed to smoke inside the facility and have not seen a resident smoke inside the facility. In addition, 5 out of the 5 staff also stated the facility has a designated smoking area outside for residents and staff ensures residents are smoking at the designated area. LPA observed staff ensuring residents smoke in the area provided for smoking.

During resident interviews, 10 out of the 10 residents stated they have not seen a resident smoke in the hallway. In addition, 10 out of the 10 residents stated the facility has an outside smoking area.
Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099 and Lic 9099C) were discussed and provided to Facility Licensee/Administrator Amelia Aladin.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
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