Complaint Investigation Report

331881358-5-1-2024-18-AS-TDAN-D53UH5-20240508153521

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

RIVERSIDE ASC , 1650 SPRUCE ST STE 200 MS29-27

This is an official report of an unannounced visit/investigation of a complaint received in our office on

04/23/2024 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20240423144356

Staff did not ensure resident's room was free of rodents

Staff are not providing a healthful environment for resident

Licensing Program Analyst (LPA) Sara Martinez made an unannounced visit to initiate the investigation regarding the allegation(s) listed above. LPA was granted entry and met with Executive Director Diane Domingo and explained the purpose of the visit.

LPA conducted a tour of the interior/exterior areas of the facility, conducted interviews, and requested copies of pertinent documentation. Interview with Executive Director Domingo revealed Resident One (R1) lives in the independent living units at the facility. Record review of the facility's assisted living and memory care resident roster confirmed R1 lives in the facility's independent living units which is not licensed by the Department and Community Care Licensing (CCL) does not have jurisdiction over the independent living units of the facility. Therefore the allegation(s) listed above has been deemed UNFOUNDED at this time. A finding that the complaint is unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis. Cross reports will be made to notify the appropriate parties of the concerns reported. A exit interview was conducted and a copy of this report along with LIC811 - confidential names list was provided to Domingo.