336426242-6-23-2020-18-AS-NBRN-BR3RA3-20200630125025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426242
Report Date: 06/23/2020
Date Signed: 06/23/2020 03:43:46 PM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2020 and conducted by Evaluator Susan Parker

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200617110234

FACILITY NAME:	WELBROOK SENIOR LIVING ARLINGTON		FACILITY NUMBER:	336426242
ADMINISTRATOR:	FRANCO, KATHLEEN ("KATHY")		FACILITY TYPE:	740
ADDRESS:	7858 CALIFORNIA AVE		TELEPHONE:	(951) 687-2241
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	140	CENSUS: 94	DATE:	06/23/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Karen Moore		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff failed to safeguard resident's personal belongings
Resident sustained unexplained injuries while in care
Staff failed to provide comfortable accommodations for resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst Susan Parker contacted the facility via FaceTime, due to COVID-19, to commence a complaint investigation. LPA identified herself and discussed the purpose of the call and the elements of the allegations with Karen Moore, Interim Executive Director.

The investigation consisted of the following: LPA Parker interviewed 5 staff, resident #1, obtained a copy of resident #1's Pre-placement Appraisal, and LPA obtained copies of special incident reports.

The investigation revealed the following: Regarding the allegation "staff failed to safeguard resident's personal belongings......this allegation is specific to staff not safeguarding resident #1's cell phone. LPA Parker interviewed resident #1 and the resident did not recall ever having a cell phone. LPA interviewed 5 staff and none of the staff remember resident #1 ever having a cell phone.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Susan Parker	TELEPHONE: (951) 897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020

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-20200617110234

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
RIVERSIDE, CA 92507

FACILITY NAME: WELBROOK SENIOR LIVING ARLINGTON	FACILITY NUMBER: 336426242
	VISIT DATE: 06/23/2020

NARRATIVE

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Regarding the allegation "Resident sustained unexplained injuries while in care".....LPA Parker interviewed 5 staff. One staff person only remembers seeing injuries on resident #1 about a year ago, when the resident returned to the facility after visiting with family. Another staff slightly remembers resident #1 sustaining an injury after the resident fell about a year and a half ago. The other 3 staff have not observed bruises/injuries on resident #1. Resident #1 does not recall sustaining any injuries.

Regarding the allegation "Staff failed to provide comfortable accommodations for resident while in care".....LPA Parker interviewed resident #1 and the resident said the accommodations at the facility have always been comfortable. LPA was able to see resident #1's room during the interview and LPA saw a bed, dresser, the bathroom and the room looked very comfortable and clean. LPA Parker interviewed 5 staff and none of the staff have ever seen resident #1 sleep on the floor in her room, in the hallway, or on any other floor in the facility. The staff said resident #1 has always slept in a bed.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations occurred, therefore the allegations are unsubstantiated.

An exit interview was conducted with Karen Moore, Interim Executive Director, via FaceTime and a copy of this report was provided to her. Appeal Rights were printed a provided to Ms. Moore.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Susan Parker	TELEPHONE: (951) 897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020

LIC9099 (FAS) - (06/04)

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