<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426029
Report Date: 09/23/2025
Date Signed: 09/23/2025 11:41:58 AM

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
06/18/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250618101600
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:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek timely medical care for resident.
Staff did not provide adequate housekeeping services in resident’s room.
Staff did not disinfect residents’ shared shower chair between use.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/23/2025, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to deliver the findings to the above complaint allegations. LPA met with Facility staff-LVN-Melissa Bridges and stated the purpose of this visit. Facility administrator Amelia Aladin was informed of the visit and was not present at the facility due to an appointment. The investigation consisted of staff interviews, resident interviews, and a facility tour.
During the complaint investigation: LPA toured the facility, conducted staff, resident, and outside party interviews. Reviewed facility and resident files and obtained copies of pertinent documents.

In regard to the First allegation: Staff did not seek timely medical care for resident.
During staff interviews Five (5)out of Five (5) staff members interviewed stated that they do provide timely medical care. They explained that facility nurse-LVN check residents during admission to the facility and refer them to their primary physicians if needed, and that emergency services are always contacted when a resident needs to be transported to a hospital and family, responsible parties are notified.
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 3
Control Number 56-AS-20250618101600
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During Residents interviews Eight (8) out of (8) residents interviewed also denied the allegation. They confirmed that staff members are always helpful and call for a nurse or ambulance when needed, ensuring they receive timely medical care.
The interviews with both staff and residents consistently refute the allegation, suggesting that the facility's medical care procedures are being followed effectively.

Second Allegation: Staff did not provide adequate housekeeping services in residents’ room

In regard to allegation #2, LPA Singh inspected several areas of the facility. LPA Singh did not observe the facility staff did not provide adequate housekeeping services in resident’s room. LPA Singh interviewed staff, who all denied that the facility staff did not provide adequate housekeeping services in the resident’s room. Five (5)out of Five (5) staff stated that facility staff clean the facility on a daily basis. LPA Singh also interviewed residents and 8 out of 8 residents denied that the facility Staff did not provide adequate housekeeping services in the resident’s room. Residents stated that the facility staff members clean the facility frequently and provide housekeeping services daily in the residents’ room. LPA Singh observed housekeeping staff cleaning rooms, floors etc.

Third Allegation: Staff did not disinfect residents shared shower chair between use.

In regard to allegation #3, LPA Singh inspected several areas of the facility. LPA Singh interviewed staff, five (5) out of five (5) denied that the facility Staff did not disinfect residents shared shower chair between use in the bathroom. Five (5) out of five (5) staff stated that facility staff clean the facility daily and disinfect the bathroom and shower chair between use by the residents in care. LPA Singh also interviewed residents and 8 out of 8 residents denied that the facility Staff did not disinfect residents shared shower chair between use. All 8 out of 8 residents stated that the facility staff members clean the facility frequently and Staff disinfects residents shared shower chair or bathroom between use. In addition, residents stated that staff follows the infection protocols and disinfect all the areas between used by the residents.

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 3
Control Number 56-AS-20250618101600
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on the evidence found during the investigation, the three (3) allegations-Staff did not seek timely medical care for resident, Staff did not provide adequate housekeeping services in resident’s room and Staff did not disinfect residents’ shared shower chair between use listed above are 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 Facility staff-LVN-Melissa Bridges.

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: 3 of 3