336426242-11-22-2022-18-AS-JDHS-CLX2VM-20221208164406

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426242
Report Date: 11/29/2021
Date Signed: 11/22/2022 04:27:30 PM

Unsubstantiated

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
04/22/2020 and conducted by Evaluator Yolanda Delgado

COMPLAINT CONTROL NUMBER: 18-AS-20200422113250

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:	0	CENSUS: 0	DATE:	11/29/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Lori Spencer, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff neglect resulted in a resident being hospitalized

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yolanda Delgado arrived at the facility to conclude a complaint investigation into the allegation noted above. LPA met with current Administrator Lori Spencer. Due to change of ownership of Welbrook Senior Living Arlington, #336426242, facility was closed effective 11/17/2020. Due to COVID-19 restrictions, there was a delay in findings. During the investigation LPA interviewed S1 that was employed during the time frame, reviewed previous resident's medical records from hospital visits and residents medical file and there was no neglect from staff at the facility after review of records and Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Administrator Spencer and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-0337
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

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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