336426029-3-3-2025-56-AS-EMAN-DEVMZS-20250318100338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 03/03/2025
Date Signed: 03/03/2025 01:24:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
02/28/2025 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250228140105

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: 51	DATE:	03/03/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Facility Nurse Melissa Bridges and Administrator Amelia Aladin		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident smoking in the hallway.
Pests in the rooms.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Facility Nurse Melissa Bridges and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and facility tour.

For the allegation, Resident smoking in the hallway.

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.

During resident interviews, 7 out of the 8 residents stated they have not seen a resident smoke in the hallway. In addition, 7 out of the 8 residents stated the facility has an outside smoking area.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

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-20250228140105

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CALOAKS SENIOR LIVING	FACILITY NUMBER: 336426029
	VISIT DATE: 03/03/2025

NARRATIVE

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During facility tour, LPA did not observe residents smoking inside the facility. LPA observed resident’s cigarettes locked inside the medication room and observed the facility had a designated smoking area outside the facility.

For the allegation, Pests in the room.

During staff interviews, 5 out of the 5 staff stated they have not seen pest inside the facility. During resident interviews 8 out of the 8 resident stated they have not seen pest inside their room.

During document review, LPA observed the facility receives pest control maintenance once a month.

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) was discussed and provided to Facility Nurse Melissa Bridges.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

LIC9099 (FAS) - (06/04)

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