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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881480
Report Date: 07/14/2025
Date Signed: 08/21/2025 01:34:11 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
08/02/2024 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240802094711
FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331881480
ADMINISTRATOR:WILLIAMS, MORGANFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:232CENSUS: 102DATE:
07/14/2025
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Crystal Rulas-Maldonado, Business Office ManagerTIME COMPLETED:
12:02 PM
ALLEGATION(S):
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9
Staff illegally evicted resident.
INVESTIGATION FINDINGS:
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13
On 07/14/2025 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegations noted above. LPA met with Crystal Rulas-Maldonado, Business Office Manager, where LPA explained the purpose of the visit and the elements of the allegations. The allegations were investigated, and the investigation consisted of interviews and records review.

It was alleged staff illegally evicted Resident 1 (R1). R1 was issued an eviction notice on 05/21/2024, for failing to pay. A review of the eviction notice revealed that it met Title 22 regulatory requirements. It was further alleged that R1 was denied access to their room upon their return to the facility. Staff reported R1 was out of the facility from 07/20/2024 through 08/03/2024. Upon R1’s return to the facility, R1 was relocated to a model room, because their room was being treated for pests. R1 was then moved back into their original room on or around 08/27/2024. A review of the facility’s Acknowledgement of Discharge form dated 11/11/2024, revealed R1 vacated the facility on 11/11/2024. On that date R1’s responsible person removed all personal belongings. The form was signed by R1’s responsible person.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
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 4
Control Number 18-AS-20240802094711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ARLINGTON RIVERSIDE SENIOR COMMUNITY
FACILITY NUMBER: 331881480
VISIT DATE: 07/14/2025
NARRATIVE
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It was further alleged staff called local law enforcement regarding R1’s eviction. Staff deny calling the police on R1 for an eviction. A review of charting notes for R1, revealed that local law enforcement was contacted and it involved R1, however, that call was done on 08/05/2024. This occurred after the date this complaint was received. This complaint was received on 08/02/2024. Furthermore, the reason for the call to local law enforcement on 08/05/2024, according to the charting note, was for something other than an eviction. LPA attempted to interview R1, however R1 no longer resides at the facility. Attempts to contact R1 via telephone were unsuccessful. Based on insufficient evidence to corroborate or refute the allegation, the allegation of staff illegally evicted a resident is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted, and a copy of this report was reviewed and provided to Crystal Rulas-Maldonado, Business Office Manager.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
08/02/2024 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240802094711

FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331881480
ADMINISTRATOR:WILLIAMS, MORGANFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:232CENSUS: 102DATE:
07/14/2025
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Crystal Rulas-Maldonado, Business Office ManagerTIME COMPLETED:
12:02 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff withheld resident's personal belongings.
Staff did not provide resident with new bed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/14/2025 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegations noted above. LPA met with Crystal Rulas-Maldonado, Business Office Manager, where LPA explained the purpose of the visit and the elements of the allegations. The allegations were investigated, and the investigation consisted of interviews and records review.

Regarding the allegation of staff withheld resident's personal belongings. It was alleged that facility staff withheld R1’s personal belongings and valuables: TV, laptop, dresser, 2 nightstands, linens, hygiene products, and all personal clothing. A records review of R1s Personal Property and Valuables List dated 04/04/2021, was reviewed which revealed it was not completed as there was a line through the form, the form did not include any updates of items purchased throughout the duration of R1’s placement at the facility. A review of the facility’s Acknowledgement of Discharge form dated 11/11/2024, revealed R1 vacated the facility on 11/11/2024. On that date R1’s responsible person removed all personal belongings. The form was signed by R1’s responsible person. There is no documentation of the specific

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20240802094711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ARLINGTON RIVERSIDE SENIOR COMMUNITY
FACILITY NUMBER: 331881480
VISIT DATE: 07/14/2025
NARRATIVE
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Regarding the allegation of staff withheld resident's personal belongings. It was alleged that facility staff withheld R1’s personal belongings and valuables: TV, laptop, dresser, 2 night stands, linens, hygiene products, and all personal clothing. A records review of R1s Personal Property and Valuables List dated 04/04/2021, was reviewed which revealed it was not completed as there was a line through the form, the form did not include any updates of items purchased throughout the duration of R1’s placement at the facility.

A review of the facility’s Acknowledgement of Discharge form dated 11/11/2024, revealed R1 vacated the facility on 11/11/2024. On that date R1’s responsible person removed all personal belongings. The form was signed by R1’s responsible person. There is no documentation of the specific items picked up.

LPA conducted an interview with a resident witness (RW). RW reported the laptop was given to them directly from R1 a few months before R1 discharged from the facility. RW also reported on the day R1’s responsible person was collecting R1’s belongings in November of 2024, RW was given R1’s TV, 2 night stands and decorative pillows. RW stated they were close with R1 and it was already agreed upon that R1 would give those items to RW. LPA attempted to interview R1, however R1 no longer resides at the facility. Attempts to contact R1 via telephone were unsuccessful.

It was alleged R1 was informed by previous Executive Director Morgan Williams that their bed was infested and that it would be replaced with a new one. During the investigation, the facility did not have a record available for LPA to review, proving that a new bed was purchased for R1. LPA attempted to interview R1, however R1 no longer resides at the facility. Attempts to contact R1 via telephone were unsuccessful.

Based on observations and interviews the allegations are unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of this report was reviewed and provided to Crystal Rulas-Maldonado, Business Office Manager.
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4