336426242-6-16-2021-18-AS-EMAN-C4FP9H-20210629110710

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426242
Report Date: 06/16/2021
Date Signed: 06/16/2021 04:59:27 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
06/29/2020 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200629160551

FACILITY NAME:	WELBROOK SENIOR LIVING ARLINGTON		FACILITY NUMBER:	336426242
ADMINISTRATOR:	PENDING		FACILITY TYPE:	740
ADDRESS:	7858 CALIFORNIA AVE		TELEPHONE:	(951) 687-2241
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	140	CENSUS:	DATE:	06/16/2021
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Lori Spencer		TIME COMPLETED:	05:04 PM

ALLEGATION(S):

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Residents are being isolated.
Residents' phones are being taken away.
Residents are not receiving mail.
Residents are not allowed to vote.
Residents are not allowed to have visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Natalie Gayoso and Anna Bueno conducted an unannounced visit to the facility to conduct a complaint investigation. LPAs identified themselves and discussed the purpose of the visit with Lori Spencer, Executive Director. The investigation consists of staff and resident interviews, and LPAs’ observations and reviews of pertinent documents.

Allegation 1: Residents are being isolated.
LPAs Gayoso and Bueno interviewed staff and residents. Five of five staff members and R2 and R3 stated that isolation procedures applied to those who were Covid-19 positive. S1 and S2 stated that the facility had Covid-19 outbreaks between from June through December 2020 so the facility had physical restrictions. R2 and R3 confirmed that staff kept them engaged by stopping by their rooms and/or providing individual activity packets. R4 and R5 stated that they do not recall being in isolation at any time. This allegation regarding resident isolation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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-20200629160551

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: 06/16/2021

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	No deficiencies have been cited at this time. An exit interview was conducted where this report was discussed, and a copy was provided to the Executive Director.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 18-AS-20200629160551

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: 06/16/2021

NARRATIVE

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isolation is unsubstantiated.

Allegation 2: Residents' phones are being taken away.
LPAs observed that R2 and R3 had their cellphones during the interview and stated that at no time have their phones been taken away from them, even when Covid-19 procedures were in place. R4 and R5 do not know if they have cellphones but stated that there is a facility phone available for them to use should they want to contact family or friends. The allegation regarding phones being taken away is unsubstantiated.

Allegation 3: Residents are not receiving mail.
R2 and R3 stated in their individual interviews that they have not had any unexplained interruptions receiving mail and have received their mail and packages in time. LPAs observed that there are residential mailboxes and saw R2 open their mailbox for this day’s delivery. The allegation of not receiving mail is therefore unsubstantiated.

Allegation 4: Residents are not allowed to vote.
Interviews with five of five staff members confirmed that the facility has a polling place set up in the independent living building. R2 and R3 confirmed that they have been able to and have voted without restrictions or conditions. LPAs reviewed a facility poster offering transportation to those who would like to vote at the local polling station. The allegation regarding not being able to vote is unsubstantiated.

Allegation 5: Residents are not allowed to have visitors.
LPAs Gayoso and Bueno observed several visitors signing in the facility during this visit. Two of two residents from assisted living stated that physical visitations were restricted during active Covid-19 cases, but they have been using their cellphones to communicate with loved ones during this time. All staff members stated that at no time did visits stopped but safer alternative options were available, such as scheduled outdoor or window visits. This allegation regarding not allowing visitors is unsubstantiated.

Based on interviews and observations, findings for the above allegations are therefore 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 violations did or did not occur, therefore the allegations are unsubstantiated at this time.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC9099 (FAS) - (06/04)

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