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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881480
Report Date: 07/14/2025
Date Signed: 08/12/2025 11:25:12 AM

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
07/18/2024 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240718105822
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:
12:02 PM
MET WITH:Molly Bowie, Executive Director TIME COMPLETED:
03:05 PM
ALLEGATION(S):
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9
Staff does not ensure resident has electricity.
INVESTIGATION FINDINGS:
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On 07/14/2025 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation noted above. LPA met with Executive Director (ED) Molly Bowie, where LPA explained the purpose of the visit and the elements of the allegation. The allegation was investigated, and the investigation consisted of interviews and records review. On 08/02/2024 Community Care Licensing received a complaint alleging staff did not ensure resident had electricity.

It was alleged Resident 1 (R1) returned to the facility to find their room had no electricity. The LPA was unable to determine the date of occurrence. LPA attempted to interview R1 but was unsuccessful. The ED was interviewed and reported they had never been informed that R1 was without electricity. The ED further reported they had an exterminator company providing services which consisted of electrical outlet covers being removed to allow for powder to be inserted. However, at no time was the electricity turned off. The LPA obtained a copy of a document titled “Bedbug Conventional Treatment Preparation Checklist” from the ED. The checklist gave instructions on what to do before and after the service has been rendered. The checklist did not note anything concerning the electricity.
The LPA received a video and it was reviewed. The video depicted a dark room. It appeared the individual filming was using a cell phone with the flashlight on. In the background was a nightstand which held a white rectangular shaped box that had a green light illuminating from it. An interview with the individual who made the video could not be conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
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 5
Control Number 18-AS-20240718105822
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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The LPA conducted a random sampling of interviews with other residents. These residents occupied the same floor as well as other areas of the facility. These interviews revealed that 4 of 4 residents reported they never were without electricity.

Based on interviews and records review, the allegation of staff did not ensure resident had electricity is unsubstantiated. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur.

An exit interview was conducted where a copy of this report was reviewed and provided to Molly Bowie Executive Director.
SUPERVISORS NAME: Anthony Perez
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 5
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
07/18/2024 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240718105822

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:
12:02 PM
MET WITH:Molly Bowie, Executive Director TIME COMPLETED:
03:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not keep resident’s room free from bed bugs
Staff disturbing resident’s sleep.
Staff isolating residents.
INVESTIGATION FINDINGS:
1
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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 Executive Director (ED) Molly Bowie, 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.

On 07/18/2024 Community Care Licensing received a complaint alleging staff did not keep resident’s room free from bed bugs, staff disturb resident’s sleep, and staff isolate residents. Regarding the allegation staff did not keep Resident 1’s (R1) room free from bed bugs, the LPA received a video and it was reviewed. The video depicted a dark room. It appeared the individual filming was using a cell phone with the flashlight on. The video depicted a bed with a mattress covered in a white fitted sheet. On the fitted sheet were bugs crawling. There is no date stamp on the video reviewed. An interview with the individual who made the video could not be conducted. The LPA obtained a copy of the contract between the facility and an exterminator company.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
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 5
Control Number 18-AS-20240718105822
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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The LPA reviewed the document titled “Commercial Services Agreement” dated 07/18/2023. The agreement was for the exterminator company to come out two times a month. The Service Report dated 07/13/2024 indicated bed bug activity was found in room 265 and the room was treated. R1 resided in room 265. An Odd Job form was reviewed dated 08/23/2024 which indicated treatment to room 265 and no bed bug activity was found. Another Odd Job form dated 08/26/2024 indicated multiple rooms were inspected, including room 265, and no live activity was found. The exterminator company made a recommendation to remove all infested furniture from all the rooms. Per an invoice dated 10/01/24, the facility disposed of the items on 09/14/24, and 09/28/24. The LPA was unsuccessful in interviewing R1. The LPA was unable to determine how long the bed bugs had been in the room prior to the treatment on 07/13/2024.


Staff disturbing resident’s sleep.
It was alleged construction in the facility was being done at all hours of the night, disturbing the sleep for the residents. The facility was undergoing construction which included painting, replacing carpet and tile flooring, hanging art and replacing furniture. The ED was interviewed and reported the time frame for the construction was June of 2024 through February 2025. She reported that during that time frame, there were two overnight projects that were approved to be completed. She further reported the approved projects did not restrict resident movement nor did it consist of loud noises. Bowie could not recall receiving any noise complaints from residents. Bowie further stated that the only noisy/loud part was when the tiles in the dining room were replaced and that project was only completed during the day from 9am-2pm. R1 was unable to be interviewed. Other resident interviews were conducted where 4 of 4 reported they did not have their sleep disturbed nor did they hear complaints from any other residents regarding the construction.
SUPERVISORS NAME: Anthony Perez
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 5
Control Number 18-AS-20240718105822
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
1
2
3
4
5
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Staff isolating residents.
It was alleged that staff told residents to stay in their rooms to benefit the facility, because the facility was short staffed. The ED denies residents were asked to isolate. She also denied being short staffed. She stated there are 3 shifts. The AM shift consists of 2 med techs and 4 caregivers, the PM shift consists of 2 med techs and 2-3 caregivers and the NOC shift consists of 1 med tech with 1-2 caregivers. R1 was not available to interview. Other resident interviews were conducted where 4 of 4 reported they were not told to isolate or stay in their rooms.

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

An exit interview was conducted where a copy of this report was reviewed and provided to Molly Bowie Executive Director.
SUPERVISORS NAME: Anthony Perez
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: 5 of 5