336426029-2-27-2025-18-AS-EMAN-DG2TLA-20250424144912

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 02/27/2025
Date Signed: 02/27/2025 04:28:02 PM

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
05/17/2021 and conducted by Evaluator Beena Singh

COMPLAINT CONTROL NUMBER: 18-AS-20210517155515

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: 57	DATE:	02/27/2025
		UNANNOUNCED	TIME BEGAN:	03:36 PM
MET WITH:	Licensee/Administration-Amelia Aladin		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff not allowing resident to leave facility.
Facility has insects.
Staff did not safeguard resident's personal property.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Beena Singh and LPA Melody Brown conducted an unannounced visit to deliver findings on the allegations listed above. LPAs met with Facility Licensee/administrator Amelia Aladin and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and record reviews.

The investigation was conducted by LPA Stephanie Torres, LPAs Beena Singh and Melody Brown

First Allegation, Staff not allowing resident to leave facility.
During the interviews with residents six (6) out of 6 residents stated that they never had any issues with leaving facility and staff helps them if residents wants to go out with family or friends. Interviews with six(6) of 6 staff indicated that residents were allowed to leave the facility anytime they prefer. During the faciltiy visit today, 2/27/2025 LPAs Singh and Brown observed residents leaving the facility without restrictions.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Beena Singh	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

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 18-AS-20210517155515

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: 02/27/2025

NARRATIVE

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Second Allegation, Facility has insects.
During the interviews with Six (6) out of 6 residents indicated that they did not see any bedbugs, cockroaches or any insects in the facility. Interviews with six(6) staff indicated that there's no bed bugs or roaches at the facility. On 2/26/2025 LPAs Singh and Brown did not observed bedbugs or roaches at the facility.

Third Allegation, Staff did not safeguard resident's personal property.
During the investigation, LPA Singh interviewed residents and staff. Six (6) out of 6 residents indicated that facility do not have any issues of personal property being lost. Six(6) of 6 staffs interviewed reported that staff take good care of personal property of residents, sometimes laundry clothes get mixed up with other residents, but staff do their best to find residents laundry and give them back.

Based on the evidence gathered during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted where this report, LIC9099 and LIC 9099C were discussed and provided to Facility Licensee/ administrator Amelia Aladin.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Beena Singh	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

LIC9099 (FAS) - (06/04)

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