<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208818
Report Date: 03/15/2024
Date Signed: 03/15/2024 02:32:57 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, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/22/2023 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20231222121140
FACILITY NAME:RIVERSIDE SENIOR CAREHOMEFACILITY NUMBER:
107208818
ADMINISTRATOR:BAUTISTA, ARLENEFACILITY TYPE:
740
ADDRESS:7435 N RIVERSIDE DRIVETELEPHONE:
(559) 412-8684
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 6DATE:
03/15/2024
UNANNOUNCEDTIME BEGAN:
11:57 AM
MET WITH:Arlene BautistaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff sexually abused residents in care
Staff conduct poses a risk to residents in care
Staff do not properly store resident's medications
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Katie Brown arrived unannounced to the facility to conduct a subsequent complaint visit. LPA met with and explained the reason for the visit with Arlene Bautista.

During the visit, LPA toured the facility and conducted interviews.

The Department investigated the allegations listed above. Based on interviews, Staff (S1) has not been terminated from the facility. S1 has not been written up or removed from the facility due to allegations by residents or family members. There was nothing in S1’s employment file to document termination or restrictions to work. Interviews conducted of staff and residents did not reveal any concerns or reports of inappropriate behavior.

See LIC9099C for continuation of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20231222121140
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: RIVERSIDE SENIOR CAREHOME
FACILITY NUMBER: 107208818
VISIT DATE: 03/15/2024
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
Interviews reveal that the facility did experience a Covid outbreak in October 2023. The facility reported the outbreak to all parties as required. The facility Infection Control Plan was reviewed. Staff were not observed coughing or violating Infection Control guidelines during multiple visits. There was no evidence of staff or residents smoking in an unsafe or unlawful manner.

Based on observations during facility visits on 12/26/23, 12/28/23, 2/21/24 and 3/15/24 medications were properly stored and locked.

Based on interview, record review and observation, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur.

There were no citations issued. An exit interview was conducted and a copy of this report was emailed to AD, whose signature confirms receipt of these documents.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2