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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881480
Report Date: 07/26/2025
Date Signed: 07/26/2025 04:59:11 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
06/25/2024 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240625083051
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: 100DATE:
07/26/2025
UNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Crystal Ruelas /Business Office ManagerTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not administer resident’s medication as prescribed.
Staff did not provide a safe environment for residents.
Staff did not ensure that the facility was in good repair.
INVESTIGATION FINDINGS:
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On 7/26/2025 at approximately 8:10 AM, LPA Alfonso Iniguez conducted a subsequent unannounced complaint visit. LPA Iniguez met with Crystal Ruelas /Business Office Manager. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Culinary Director Interview (A#1), Residents Interviews (R#1-R#10) and Staff Interview (S#1-S#5). LPA obtained and reviewed the following documents: Resident Roster dated: 7/26/25, Staff Roster dated: 7/26/25, copies of (R#1)’s Medication Administration Records (MARs) dated: June 2024 through October 2024 and a Health and Safety check of the facility ( 10 randoms residents rooms: 201, 216, 222, 229, 241, 141, 145, 134, 138 and 137) and the facility elevators.


Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025
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-20240625083051
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: 07/26/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Staff did not administer resident’s medication as prescribed.

The details of the complaint alleged that facility staff is not administering to (R#1) their medication as prescribed.



On July 26, 2025, at approximately 9:00 a.m., during a records review, LPA Iniguez examined (R#1)’s Medication Administration Records (MARs) from June 2024 to October 2024. LPA Iniguez noted that (R#1) received their pain medications as prescribed by the physician.

On July 26, 2025, at approximately 11:00 a.m. LPA Iniguez conducted an interview with the Business Office Manager (A#1). During the interview, (A#1) stated that the Medtech’s are responsible for dispensing medications. They receive training from the pharmacy, supervisors, and through Relias, as well as one-on-one instruction. In addition, (A#1) also confirmed that (R#1) and the other residents in care received their medications as prescribed by their physician.

On July 25, 2025, at approximately 9:30 AM, LPA Iniguez contacted (R#1) by telephone, but (R#1) did not answer. LPA Iniguez left a voice message. At around 10:30 AM on the same day, LPA Iniguez attempted to reach (R#1) again, but once more, (R#1) did not pick up, and a voice message was left. For a third time, at approximately 11:30 AM, LPA Iniguez called (R#1), who again did not answer, prompting another voice message to be left.

On July 26, 2025, at approximately 1:00 PM, during interviews with residents (R#2-R#10), (9) out of (9) stated that they take medication and they have never missed a dose of their prescribed medications.



Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20240625083051
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: 07/26/2025
NARRATIVE
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On July 26, 2025, at approximately 11:00 AM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that the person who administers medication to the residents is the MedTech, and they believe the MedTech’s are trained on how to do their job. Additionally, (5) out of (5) facility staff stated that (R#1) and the other residents in care got their medications as prescribed by their physician.

Allegation: Staff did not provide a safe environment for residents.

The details of the complaint alleged that facility is not providing a safe environment for (R#1) and the rest of the residents in care.



n July 26, 2025, at approximately 4:00 PM, LPA Iniguez conducted a Health and Safety check of the facility, touring the premises with (A#1). During the inspection, LPA Iniguez did not observe any immediate dangers to the residents in care in either the first or second floor common areas.

On July 26, 2025, at approximately 11:00 a.m., during an Interview with the Business Officer Manager (A#1), she stated that the facility staff, including herself, provides a safe environment for (R#1) and the rest of the residents in care.

On July 25, 2025, at approximately 9:30 AM, LPA Iniguez contacted (R#1) by telephone, but (R#1) did not answer. LPA Iniguez left a voice message. At around 10:30 AM on the same day, LPA Iniguez attempted to reach (R#1) again, but once more, (R#1) did not pick up, and a voice message was left. For a third time, at approximately 11:30 AM, LPA Iniguez called (R#1), who again did not answer, prompting another voice message to be left.

On July 26, 2025, at approximately 1:00 PM, during interviews with residents (R#2-R#9), (9) out of (9) stated that they agree the facility staff provides a safe environment for them and the rest of the residents, and they feel safe living here.



Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20240625083051
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: 07/26/2025
NARRATIVE
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On July 26, 2025, at approximately 11:00 AM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that they do provide a safe environment for (R#1) and the rest of the residents in care.

Allegation: Staff did not ensure that the facility was in good repair.

The details of the complaint alleged that two facility elevators were in disrepair.



On July 12, 2025, at approximately 4:00 PM, during a health and safety check of the facility, LPA Iniguez observed that the elevators were functioning properly at the time of his visit.

On July 26, 2025, at approximately 11:00 AM, during an Interview with the Business Officer Manager (A#1), she stated that the facility has two elevators. When one of the elevators is in disrepair, they contact the technician right away. Additionally, (A#1) stated that the elevators have never been out of disrepair for more than a week.

On July 25, 2025, at approximately 9:30 AM, LPA Iniguez contacted (R#1) by telephone, but (R#1) did not answer. LPA Iniguez left a voice message. At around 10:30 AM on the same day, LPA Iniguez attempted to reach (R#1) again, but once more, (R#1) did not pick up, and a voice message was left. For a third time, at approximately 11:30 AM, LPA Iniguez called (R#1), who again did not answer, prompting another voice message to be left.

On July 26, 2025, at approximately 1:00 PM, during interviews with residents (R#2-R#9), (9) out of (9) stated that the elevators have never been in disrepair for more than one week.



On July 26, 2025, at approximately 11:00 AM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that there are two elevators at the facility and there are never in disrepair more than one week.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20240625083051
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: 07/26/2025
NARRATIVE
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During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.


An exit interview was conducted, and a copy of the Complaint Report was given to Crystal Ruelas/Business Office Manager.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5