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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 09/23/2025
Date Signed: 09/23/2025 12:56:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
09/17/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250917095925
FACILITY NAME:CALOAKS SENIOR LIVINGFACILITY NUMBER:
336426029
ADMINISTRATOR:AMELIA ALADINFACILITY TYPE:
740
ADDRESS:3891 POLK STREETTELEPHONE:
(951) 689-6162
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:74CENSUS: 52DATE:
09/23/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Facility staff-LVN- Melissa BridgesTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Licensee is not ensuring that staff follow proper infection control protocols.
INVESTIGATION FINDINGS:
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On 9/23/2025, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to initiate and deliver the findings to the above complaint allegation. LPA Singh met with Facility staff-LVN- Melissa and stated the purpose of this visit. Licensee/ Administrator, Amelia Aladin was been informed of the visit and arrived during this visit. The investigation consisted of staff interviews, resident interviews, and a tour of the facility.

In regard to allegation, Licensee is not ensuring that staff follow proper infection control protocols. LPA Singh inspected several areas of the facility. LPA Singh observed the facility Staff disinfect the facility and residents are being isolated and monitored. At the entrance of the facility "No visitors sign" is being displayed and side door has been used for the entry and masks, hand hygiene protocol has been enforced by the staff. During LPA Singh's visit to the facility, residents were being quarantined, staff and residents wearing masks. Eight (8) out of eight (8) residents stated that they have been isolated if they are positive for Covid-19.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 2
Control Number 56-AS-20250917095925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CALOAKS SENIOR LIVING
FACILITY NUMBER: 336426029
VISIT DATE: 09/23/2025
NARRATIVE
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LPA Singh interviewed staff, five (5) out of five (5) denied that the facility Licensee is not ensuring that staff follow proper infection control protocols. Five (5) out of Five (5) staff stated that facility staff clean the facility daily and disinfect the facility and residents rooms. Staff stated that residents have been isolated and following the infection protocols. LPA Singh also interviewed residents and 8 out of 8 residents denied that the facility Licensee/staff is not ensuring that staff follow proper infection control protocols.

Based on the evidence found during the investigation, the allegation:-Licensee is not ensuring that staff follow proper infection control protocols, listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099 and Lic 9099C) were discussed and provided to Facility Licensee/ Administrator, Amelia Aladin.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2