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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881480
Report Date: 07/27/2025
Date Signed: 07/27/2025 01:27:32 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:
07/27/2025
UNANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Breanna Jones/Phych Tech.TIME COMPLETED:
01:27 PM
ALLEGATION(S):
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Staff did not provide a comfortable temperature for resident.
Staff did not treat resident with respect.
INVESTIGATION FINDINGS:
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On 7/27/2025 at approximately 8:30 AM, LPA Alfonso Iniguez conducted a subsequent unannounced complaint visit. LPA Iniguez met with Breanna Jones/Phych Tech. 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 and Copies of Facility Staff Trainings regarding residents rights dated:2025.


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: 07/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2025
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-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: 07/27/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Staff did not provide a comfortable temperature for resident.

The details of the complaint alleged that the air conditioning on (R#1)’s room was in disrepair.



On July 26, 2025, at approximately 4:00 PM, during a health and safety check of the facility, LPA Iniguez observed the former room #201 of (R#1). LPA noted that the air conditioning vent was functioning properly. Additionally, LPA Iniguez inspected (9) other residents' rooms—#216, #222, #229, #241, #141, #145, #134, #138, and #137—and confirmed that the air conditioning units and vents in all inspected rooms were working correctly.

On July 26, 2025, at approximately 11:00 AM, during an Interview with the Business Officer Manager (A#1), she stated that all residents’ air conditioning units work correctly, including room 201.

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#1-R#9), (9) out of (9) stated that their air conditioning unit works properly.



On July 26, 2025, at approximately 11:00 AM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that all residents’ air conditioning units work properly.

Evaluation Report continues LIC 9099-C

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

DATE: 07/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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: 07/27/2025
NARRATIVE
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Allegation: Staff did not treat resident with respect.

The details of the complaint alleged that the facility staff did not treat (R#1) with respect.



On July 26, 2025, at approximately 3:30 p.m., during the records review, LAP Iniguez obtained copies of Facility Staff Trainings regarding residents' rights dated 2025. LPA Iniguez noticed that all facility staff have already taken the training regarding residents' rights this year.

On July 26, 2025, at approximately 11:00 a.m., during an Interview with the Business Officer Manager (A#1), she stated that staff are trained in residents' rights annually and upon hire.

On July 25, 2025, at approximately 9:30 a.m., LPA Iniguez contacted (R#1) by telephone, but (R#1) did not answer. LPA Iniguez left a voice message. At around 10:30 a.m. 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 a.m., 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 p.m., during interviews with residents (R#1-R#9), (9) out of (9) stated that they have never been disrespected by facility staff.

On July 26, 2025, at approximately 11:00 a.m., during interviews with facility staff (S#1-S#5), (5) out of (5) stated that they get trained regarding residents' rights mostly every year, and they have never disrespected any resident in care.

Evaluation Report continues LIC 9099-C

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

DATE: 07/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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: 07/27/2025
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 Breanna Jones/Phych Tech.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4