Inspection Reports for Meridian of Riverside
4609 Arlington Ave, Riverside, CA 92504, United States, CA, 92504
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, with several complaint investigations determined to be unsubstantiated. However, some investigations substantiated issues related to resident care, including delays in incontinence care, medication mismanagement, failure to provide timely medical treatment leading to serious injury, and pest control concerns. The facility was cited for deficiencies in these areas but did not face fines or enforcement actions listed in the available reports. The most recent report from September 24, 2025, was clean with no deficiencies noted. This suggests some improvement in compliance, though past findings highlight areas where resident care and safety required attention.
Deficiencies (last 2 years)
Deficiencies (over 2 years)
5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
25% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
41% occupied
Based on a September 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 96
Capacity: 232
Deficiencies: 0
Date: Sep 24, 2025
Visit Reason
An unannounced complaint investigation was conducted regarding an allegation that a resident hit another resident due to staff neglect.
Complaint Details
The complaint alleged that a resident hit another resident due to staff neglect. The investigation included interviews with residents, staff, and witnesses, as well as observations and record reviews. The allegation was found unsubstantiated.
Findings
Based on interviews, observations, and record reviews, the allegation was deemed unsubstantiated as there was insufficient evidence to prove the alleged violation occurred. No injuries or physical markings consistent with assault were observed, and staffing levels were adequate.
Report Facts
Capacity: 232
Census: 96
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Armando Perez | Licensing Program Analyst | Conducted the complaint investigation and observations |
| Olga Morales | Wellness Director | Met with the Licensing Program Analyst during the investigation and received the report |
| Molly Bowie | Executive Director | Provided information during the investigation regarding staff and resident interactions |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 232
Deficiencies: 0
Date: Aug 21, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that the facility did not allow a resident visitors.
Complaint Details
The complaint alleged that a resident's visitor was told to leave due to facility insurance restrictions. The investigation included interviews with the resident, visitor, witness, and Executive Director, and a review of visitation policies. The allegation was determined to be false and without reasonable basis.
Findings
The investigation found that the allegation was unfounded. Interviews with the resident, visitor, witness, and facility staff, as well as a review of the visitation policy, showed no evidence that visitors were denied access or restricted improperly.
Report Facts
Facility capacity: 232
Resident census: 96
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Molly Bowie | Executive Director | Interviewed regarding visitation policies and allegations |
| Crystal Rulas-Maldonado | Business Office Manager | Met with Licensing Program Analyst during the visit and received the report |
Inspection Report
Census: 96
Capacity: 232
Deficiencies: 0
Date: Aug 21, 2025
Visit Reason
An unannounced case management visit was conducted to deliver amended findings pertaining to two complaint controls: 18-AS-20250505154117 and 18-AS-20240802094711.
Complaint Details
The visit was related to complaint investigations for complaint control numbers 18-AS-20250505154117 and 18-AS-20240802094711. No substantiation status is provided.
Findings
The Licensing Program Analyst met with the Business Office Manager to inform her of the visit purpose. An exit interview was conducted and a copy of the report was provided. The report includes information on deficiencies, plans of correction, civil penalties, and appeal rights, but no specific deficiencies or severity levels are detailed in the provided text.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the unannounced visit and signed the report. |
| Crystal Rulas-Maldonado | Business Office Manager | Met with the Licensing Program Analyst during the visit and received the report. |
| Molly Bowie | Administrator | Named as facility administrator. |
| Carolyn Tuba | Licensing Program Manager | Named as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 232
Deficiencies: 1
Date: Aug 20, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to address multiple allegations including illegal eviction, untimely food service, failure to follow residents' dietary plans, and pest control issues at the Arlington Riverside Senior Community facility.
Complaint Details
The complaint investigation addressed allegations of illegal eviction, untimely food service, failure to follow residents' dietary plans, and pest control issues. The illegal eviction allegation involved Resident 1 receiving an eviction notice for nonpayment, but no evidence of pressure to enroll in the Assisted Living Waiver program was found. The food service allegation was unsubstantiated after resident interviews confirmed timely meals. The dietary plan allegation involving Resident 2 was unsubstantiated due to lack of medical orders requiring a special diet. The pest control allegation was substantiated based on evidence of untreated pest sightings and lack of corrective actions.
Findings
The investigation found the allegations of illegal eviction, untimely food service, and failure to follow dietary plans to be unsubstantiated. However, the allegation regarding improper pest control was substantiated due to failure to adequately address pest sightings, posing a potential health risk to residents.
Deficiencies (1)
The facility failed to demonstrate appropriate action to mitigate pest sightings reported in specific resident rooms, posing a potential health risk to residents.
Report Facts
Capacity: 232
Census: 97
Deficiencies cited: 1
Plan of Correction Due Date: Sep 3, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Janette Romero | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Carolyn Tuba | Licensing Program Manager | Oversaw the complaint investigation |
| Breanna Jones | Wellness Coordinator | Facility staff member met during the investigation |
| Morgan Williams | Administrator | Facility administrator named in the report |
| Molly Bowie | Administrator | Interviewed regarding pest control issues and plan of correction |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 232
Deficiencies: 3
Date: Aug 20, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2025-04-08 regarding inadequate incontinence care, delayed staff response to resident requests, and improper provision of incontinence supplies at the facility.
Complaint Details
The complaint investigation was substantiated based on interviews with residents and staff, and record reviews. Allegations included residents being left in soiled diapers for extended periods, delayed staff response to call lights, and improper incontinence supplies. Multiple residents reported wait times of up to three hours for incontinence care and staff assistance.
Findings
The investigation substantiated that some residents, including Resident 1, experienced delays of up to two to three hours in receiving incontinence care and staff assistance after activating call lights. Additionally, it was found that the facility did not always provide properly sized incontinence supplies, posing potential health and personal rights risks to residents.
Deficiencies (3)
Failure to ensure incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
Failure to provide care, supervision, and services that meet individual needs delivered by sufficient, qualified, and competent staff.
Failure to provide necessary equipment and supplies for personal care and hygiene, including appropriate hygiene items such as soap and toilet paper.
Report Facts
Residents interviewed requiring incontinent care: 8
Residents reporting timely incontinent care: 3
Residents reporting delayed incontinent care: 3
Residents interviewed regarding call light response: 9
Residents reporting timely call light response: 5
Residents reporting delayed call light response: 3
Plan of Correction due dates: 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Janette Romero | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Carolyn Tuba | Licensing Program Manager | Oversaw the complaint investigation. |
| Molly Bowie | Administrator | Facility administrator involved in interviews and plan of correction development. |
| Breanna Jones | Wellness Coordinator | Met with Licensing Program Analyst during the investigation and involved in plan of correction. |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 232
Deficiencies: 0
Date: Aug 20, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to address allegations received on 2025-04-08 regarding medical treatment, timely meal transportation, and room access issues for residents.
Complaint Details
The complaint investigation addressed three main allegations: 1) staff not ensuring residents receive necessary medical treatment, 2) staff not taking residents to meals in a timely manner, and 3) residents being locked out of their rooms due to staff neglect. All allegations were found to be unfounded or unsubstantiated based on interviews and evidence.
Findings
All allegations were found to be either unfounded or unsubstantiated after interviews with residents and staff, review of records, and observations. Residents arrange their own medical appointments, meal transportation issues were resolved, and the allegation of being locked out of a room was unsubstantiated due to facility security policies.
Report Facts
Capacity: 232
Census: 97
Number of staff interviewed: 3
Number of residents interviewed: 3
Number of residents requiring assistance to meals: 3
Number of residents unavailable for interview: 1
Number of residents reporting timely meal transportation: 2
Number of resident rooms accessed by master key: 8
Number of bedrooms in facility: 9
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Janette Romero | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Carolyn Tuba | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Breanna Jones | Wellness Coordinator | Facility staff member met with during the investigation and recipient of report |
| Molly Bowie | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 232
Deficiencies: 1
Date: Aug 20, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff failed to arrange medical care appropriate to a resident's condition, resulting in serious bodily injury and hospitalization.
Complaint Details
The complaint was substantiated. The allegation was that staff failed to arrange medical care appropriate to the resident’s condition, resulting in serious bodily injury and hospitalization. The investigation included multiple unannounced inspections, interviews with staff and the resident, and review of facility, hospital, hospice, and home health records. Evidence showed delays in wound care and inadequate response to the resident's deteriorating condition.
Findings
The investigation substantiated that the facility failed to provide timely and appropriate medical care to Resident #1, leading to a severe pressure injury that required multiple hospitalizations and surgeries. Multiple staff interviews and record reviews revealed delays in wound care, inadequate staffing, poor documentation, and management pressure to avoid emergency calls.
Deficiencies (1)
Failure to arrange or assist in arranging medical and dental care appropriate to the condition of resident #1, posing an immediate health risk.
Report Facts
Facility capacity: 232
Resident census: 96
Deficiency count: 1
Plan of Correction due date: Sep 3, 2025
Wound size: 11.4
Wound size: 6.4
Wound size: 2.5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Valerie Flores | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Anthony Perez | Licensing Program Manager | Oversaw the complaint investigation |
| Brianna Jones | Wellness Coordinator | Facility staff member involved in the investigation and recipient of exit interview |
| Petricia Ward | Wellness Director | Facility staff involved in wound care management and interviews |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 232
Deficiencies: 2
Date: Aug 18, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to deliver investigative findings related to allegations concerning medication administration and pharmacy changes at the facility.
Complaint Details
The complaint investigation was substantiated for allegations that staff did not ensure residents were administered medications as prescribed and mismanaged medications. The allegation that staff changed a resident's pharmacy without consent was unsubstantiated.
Findings
The investigation substantiated that staff did not ensure residents were administered medications as prescribed and mismanaged resident medications, specifically noting delays in medication refills and documentation issues. Another allegation that staff changed a resident's pharmacy without consent was unsubstantiated.
Deficiencies (2)
1 out of 1 residents was out of their prescribed medication for multiple days, posing a potential health, safety and personal rights risk.
Failure to arrange for medical and dental care appropriate to the conditions and needs of residents, specifically related to medication administration and documentation.
Report Facts
Capacity: 232
Census: 97
Deficiencies cited: 2
Plan of Correction Due Date: Sep 5, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Valerie Flores | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Mollie Bowie | Administrator | Facility Administrator who participated in interviews and exit interview |
Inspection Report
Complaint Investigation
Census: 97
Capacity: 232
Deficiencies: 0
Date: Aug 12, 2025
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by an allegation that the facility was not meeting a resident's care needs.
Complaint Details
The complaint alleged that the facility was not meeting a resident's care needs, specifically regarding Resident #1's foot condition and wheelchair repair requests. The complaint was found unsubstantiated after interviews and records review.
Findings
The investigation found that Resident #1's feet were observed to be swollen with a toenail falling off, and their electric wheelchair had been in need of repair for months. However, the resident denied issues with their feet and seeing a doctor. Records showed treatment for a toe injury and hypertrophic toenail. The allegation was unsubstantiated due to insufficient evidence to prove the violation occurred.
Report Facts
Facility capacity: 232
Resident census: 97
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Carolyn Tuba | Licensing Program Manager | Named in report as Licensing Program Manager |
| Crystal Rulas-Maldonado | Business Office Manager | Met with Licensing Program Analyst during the visit and received exit interview |
| Olga Martinez | Wellness Director | Interviewed regarding Resident #1's wheelchair and care |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 232
Deficiencies: 0
Date: Aug 12, 2025
Visit Reason
The inspection visit was conducted as a Case Management visit in reference to complaint control number 18-AS-20240509101436.
Complaint Details
The visit was complaint-related under control number 18-AS-20240509101436. No deficiencies or substantiation status were explicitly stated in the report.
Findings
The Licensing Program Analyst conducted a tour of the facility and did not observe any health and safety concerns. Staff and resident interviews were conducted related to the complaint, and an evaluation of the information obtained will determine if further review is needed.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Debbie Palacios | Licensing Program Analyst | Conducted the Case Management visit and facility tour. |
| Molly Bowie | Executive Director | Met with Licensing Program Analyst during the visit. |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 232
Deficiencies: 0
Date: Aug 10, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations that staff were not preventing the use of illegal drugs and residents smoking cigarettes inside the facility.
Complaint Details
The complaint alleged that staff were not preventing illegal drug use and residents smoking inside the facility. Interviews with staff and residents showed no direct evidence of illegal drug use, though one resident reported smelling marijuana. Several residents admitted to smoking in rooms despite rules, with disciplinary actions documented. The allegations were determined to be unsubstantiated due to insufficient evidence.
Findings
Based on interviews with staff, residents, and review of records, there was insufficient evidence to substantiate the allegations. Some residents admitted to smoking inside rooms despite rules, but corrective actions such as write-ups and eviction processes were in place. No direct evidence of illegal drug use was found.
Report Facts
Facility capacity: 232
Resident census: 96
Number of residents interviewed: 9
Number of staff interviewed: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Christian Gutierrez | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Molly Bowie | Administrator | Facility administrator interviewed during the investigation |
| Breanna Jones | Wellness Coordinator | Met with Licensing Program Analyst during the visit and interviewed |
| Tony Vasallo | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 96
Capacity: 232
Deficiencies: 0
Date: Aug 10, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2024-07-23 regarding failure of facility staff to provide supervision and assistance with toileting to residents.
Complaint Details
The complaint alleged that facility staff failed to provide supervision to a resident in care and failed to assist a resident with toileting, including leaving a resident in soiled clothes for multiple days. Interviews with staff and residents did not support these allegations, and the complaint was determined to be unsubstantiated.
Findings
Based on interviews with staff, residents, and review of records, there was insufficient evidence to substantiate the allegations. Staff and residents generally denied the claims, and the investigation concluded the allegations were unsubstantiated.
Report Facts
Capacity: 232
Census: 96
Number of staff interviewed: 6
Number of residents interviewed: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Christian Gutierrez | Licensing Program Analyst | Conducted the complaint investigation visit and interviews |
| Morgan Williams | Administrator | Facility administrator interviewed during the investigation |
| Breanna Jones | Wellness Coordinator | Met with Licensing Program Analyst during the visit and interviewed |
| Tony Vasallo | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 232
Deficiencies: 0
Date: Jul 27, 2025
Visit Reason
This was an unannounced complaint investigation visit triggered by a complaint received on 2024-06-25 alleging that staff did not provide a comfortable temperature for a resident and did not treat the resident with respect.
Complaint Details
The complaint alleged that staff did not provide a comfortable temperature for a resident due to air conditioning disrepair and that staff did not treat the resident with respect. After interviews, document reviews, and observations, there was insufficient evidence to substantiate these allegations, and the complaint was determined to be unsubstantiated.
Findings
The investigation found that the air conditioning units in the resident rooms were functioning properly and that staff had received training on residents' rights. Interviews with residents and staff indicated no evidence of disrespectful treatment. Therefore, the allegations were found to be unsubstantiated.
Report Facts
Capacity: 232
Census: 100
Residents interviewed: 9
Staff interviewed: 5
Rooms inspected: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alfonso Iniguez | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Eva M Alvarez | Licensing Program Manager | Oversaw the complaint investigation |
| Morgan Williams | Administrator | Facility administrator named in the report |
| Breanna Jones | Psych Tech | Met with the Licensing Program Analyst during the investigation |
| Business Officer Manager | Interviewed regarding air conditioning and staff training |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 232
Deficiencies: 0
Date: Jul 27, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-07-16 regarding neglect, failure to follow resident care plans, feeding concerns, emergency call response, intoxication, and surveillance camera use at Arlington Riverside Senior Community.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included neglect/lack of supervision, staff not following resident care plans, failure to ensure resident feeding, failure to respond to emergency call systems, allowing intoxication, and allowing surveillance cameras in resident rooms. Each allegation was investigated through interviews, record reviews, and observations, with no evidence found to support the claims.
Findings
The investigation included interviews with staff and residents, record reviews, and facility tours. The Department found no preponderance of evidence to substantiate any of the allegations, resulting in all allegations being unsubstantiated.
Report Facts
Facility capacity: 232
Resident census: 100
Staff interviews: 10
Resident interviews: 9
Resident incident reports received: 5
Medication Administration Records reviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Regina Cloyd | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Breanna Jones | Psych Tech/Wellness Coordinator | Met with Licensing Program Analyst during investigation and received exit interview |
| Morgan Williams | Administrator | Facility administrator named in report header |
| Ulysses Coronel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Crystal Ruelas | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Sara Martinez | Licensing Program Analyst | Conducted initial unannounced visit to initiate investigation |
| Olga Morales | Wellness Coordinator | Met with Licensing Program Analyst during initial investigation visit |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 232
Deficiencies: 0
Date: Jul 26, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-08-21 regarding bed bugs in the facility and a resident being forced to relocate due to bed bugs.
Complaint Details
The complaint alleged that the facility and the bedroom of Resident #1 had bed bugs and that Resident #1 was forced to relocate rooms due to bed bugs. The investigation concluded the allegations were unsubstantiated.
Findings
The investigation found that the facility had an ongoing contract with a pest control company and took proactive measures to address bed bug issues. The allegations were not substantiated due to insufficient evidence.
Report Facts
Capacity: 232
Census: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emily Peraldi | Licensing Program Analyst | Conducted the complaint investigation and delivered final findings |
| Molly Bowie | Administrator | Facility Administrator involved in the investigation |
| Edgar Mendez | Culinary Manager | Met with during the investigation visit |
| Kathleen Banrasavong | Licensing Program Analyst | Conducted initial unannounced visit to initiate the investigation |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 232
Deficiencies: 0
Date: Jul 26, 2025
Visit Reason
The inspection was conducted as an unannounced complaint investigation following an allegation that a resident was hit over the head by another resident due to lack of supervision.
Complaint Details
The complaint alleged that Resident #2 hit Resident #1 over the head due to lack of supervision. The investigation included interviews, review of medical and facility records, and observations. Resident #2 refused to be interviewed. The allegation was found unsubstantiated.
Findings
The investigation found insufficient evidence to substantiate neglect or lack of supervision by facility staff. Although the incident between residents occurred, the allegation was deemed unsubstantiated.
Report Facts
Facility census: 100
Facility capacity: 232
Facility census: 105
Staff on overnight shift: 2
Medication injections per day: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emily Peraldi | Licensing Program Analyst | Conducted the complaint investigation and subsequent visit |
| Molly Bowie | Administrator | Facility administrator informed of the complaint and investigation |
| Edgar Mendez | Culinary Manager | Met with Licensing Program Analyst during the investigation visit |
| Janette Romero | Licensing Program Analyst | Conducted initial unannounced complaint investigation visit |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 232
Deficiencies: 0
Date: Jul 26, 2025
Visit Reason
The inspection was conducted as a complaint investigation following an allegation received on 2024-10-10 regarding staff mismanaging a resident's medication.
Complaint Details
The complaint alleged that staff were refusing to administer Resident #1's full medication. The investigation found that Resident #1 was sometimes non-compliant with dialysis and medication, administering insulin themselves, and that staff reminded the resident about dietary restrictions. The resident was hospitalized multiple times due to high blood sugar and diabetic ketoacidosis and was eventually moved to another facility. The allegation was deemed unsubstantiated.
Findings
The investigation included facility tours, interviews, and document reviews. The allegation that staff mismanaged Resident #1's medication was found to be unsubstantiated due to insufficient evidence.
Report Facts
Facility capacity: 232
Resident census: 100
Maximum daily dose: 20
Medication passes per day: 4
Injections per day: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Emily Peraldi | Licensing Program Analyst | Conducted the complaint investigation and delivered final findings |
| Molly Bowie | Administrator | Facility administrator informed of the investigation and findings |
| Edgar Mendez | Culinary Manager | Met with Licensing Program Analyst during the investigation visit |
| Sara Martinez | Licensing Program Analyst | Conducted the initial unannounced visit to initiate the investigation |
| Kristin Heffernan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 232
Deficiencies: 0
Date: Jul 26, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that staff did not administer resident medication as prescribed, did not provide a safe environment, and did not ensure the facility was in good repair.
Complaint Details
The complaint alleged three issues: staff not administering medication as prescribed, failure to provide a safe environment, and failure to maintain the facility in good repair. After interviews, records review, and facility inspection, all allegations were found to be unsubstantiated.
Findings
The investigation found no sufficient evidence to substantiate the allegations. Medication administration records and interviews confirmed residents received medications as prescribed. Facility safety checks and interviews indicated a safe environment was maintained. Elevator maintenance was timely, with no prolonged disrepair.
Report Facts
Capacity: 232
Census: 100
Resident interviews: 9
Staff interviews: 5
Elevators: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alfonso Iniguez | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Eva M Alvarez | Licensing Program Manager | Oversaw the complaint investigation |
| Morgan Williams | Administrator | Facility administrator named in the report |
| Crystal Ruelas | Business Office Manager | Interviewed during the investigation and received the exit report |
Inspection Report
Complaint Investigation
Census: 101
Capacity: 232
Deficiencies: 0
Date: Jul 21, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2024-05-09 regarding neglect and inadequate care related to pressure injuries, soiled bedding, and response times to call buttons.
Complaint Details
The complaint involved allegations that residents developed pressure injuries due to neglect, staff did not seek timely medical attention, residents were left in soiled bedding, and staff did not respond promptly to call buttons. The investigation included observations, interviews, and record reviews and concluded the allegations were unsubstantiated.
Findings
The investigation found that residents R1 and R2 received wound care as documented by hospice records, and there was no preponderance of evidence to substantiate the allegations of neglect, untimely medical attention, leaving residents in soiled bedding, or delayed response to call buttons. The allegations were determined to be unsubstantiated.
Report Facts
Facility capacity: 232
Census: 101
Complaint received date: May 9, 2024
Wound care frequency for R1: 3
Wound care frequency for R2: 2
Resident call response time: 15
Residents reporting delayed assistance: 2
Residents reporting timely assistance: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Debbie Palacios | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Molly Bowie | Executive Director | Met with Licensing Program Analyst during investigation |
| Rikesha Stamps | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 102
Capacity: 232
Deficiencies: 0
Date: Jul 14, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to investigate allegations that staff illegally evicted a resident, withheld the resident's personal belongings, and did not provide the resident with a new bed.
Complaint Details
The complaint alleged staff illegally evicted a resident, withheld the resident's personal belongings including valuables, and failed to provide a new bed. The investigation included interviews, records review, and attempts to contact the resident. The complaint was found unsubstantiated as there was insufficient evidence to prove the alleged violations occurred.
Findings
The investigation found that the eviction notice met regulatory requirements and the resident was relocated temporarily due to pest treatment. The allegations of illegal eviction, withholding personal belongings, and failure to provide a new bed were unsubstantiated due to insufficient evidence. The resident's belongings were removed by their responsible person upon discharge, and there was no proof a new bed was purchased.
Report Facts
Capacity: 232
Census: 102
Complaint received date: Aug 2, 2024
Eviction notice date: May 21, 2024
Resident absence period: 14
Resident discharge date: Nov 11, 2024
Law enforcement call date: Aug 5, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Morgan Williams | Executive Director | Named in allegation regarding informing resident about bed replacement |
| Crystal Rulas-Maldonado | Business Office Manager | Met with Licensing Program Analyst during the investigation and exit interview |
| Carolyn Tuba | Licensing Program Manager | Named in report as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 102
Capacity: 232
Deficiencies: 0
Date: Jul 14, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2024-07-18, including staff not ensuring a resident had electricity, staff not keeping a resident's room free from bed bugs, disturbing residents' sleep, and isolating residents.
Complaint Details
The complaint included allegations that staff did not ensure a resident had electricity, did not keep a resident's room free from bed bugs, disturbed residents' sleep due to construction, and isolated residents by telling them to stay in their rooms due to short staffing. The complaint was found unsubstantiated.
Findings
The investigation consisted of interviews, records review, and video evidence analysis. All allegations were found to be unsubstantiated due to lack of preponderance of evidence. Residents interviewed reported no issues with electricity, sleep disturbance, or isolation. Documentation and interviews with the Executive Director supported these findings.
Report Facts
Capacity: 232
Census: 102
Number of residents interviewed: 4
Exterminator visits per month: 2
Date of bed bug treatment: Jul 13, 2024
Furniture disposal dates: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Molly Bowie | Executive Director | Interviewed regarding allegations and investigation findings |
| Javina George | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Anthony Perez | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 232
Deficiencies: 0
Date: Jul 2, 2025
Visit Reason
The visit was conducted as a case management follow-up related to complaint control #18-AS-20250206161754 to deliver the amended report and obtain the necessary signature.
Complaint Details
The visit was related to complaint control #18-AS-20250206161754. The purpose was to deliver the amended report and obtain signatures; no new deficiencies or substantiation status were stated.
Findings
The Licensing Program Analyst met with the Executive Director to review and discuss the previously delivered report and the amended report. An exit interview was conducted and a copy of the report was provided to the facility representative.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Molly Bowie | Executive Director | Met with Licensing Program Analyst during the visit and discussed the amended report. |
| Armando Perez | Licensing Program Analyst | Conducted the unannounced visit and delivered the amended report. |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Annual Inspection
Census: 106
Capacity: 232
Deficiencies: 0
Date: Apr 16, 2025
Visit Reason
Licensing Program Analyst Armando Perez made an unannounced visit to the facility to conduct a required annual inspection.
Findings
The facility was found to be clean, in good repair, and compliant with regulations. Client and employee records were complete and available. No deficiencies were cited during this inspection.
Report Facts
Food supply: 1
Food supply: 2
Fire extinguisher last serviced: Jul 26, 2024
Fire drill last conducted: Apr 2, 2025
Employee records reviewed: 10
Client records reviewed: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Armando Perez | Licensing Program Analyst | Conducted the inspection and reviewed records |
| Molly Bowie | Executive Director | Met with Licensing Program Analyst during inspection |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 106
Capacity: 232
Deficiencies: 0
Date: Apr 16, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the licensee did not follow proper eviction protocols with a resident in care.
Complaint Details
The complaint alleged that Client 1 was not given adequate time to relocate and secure new housing before the eviction date. The investigation included interviews with staff and witnesses, and a review of eviction notices and court orders. The eviction was confirmed to be lawful and properly executed.
Findings
The investigation found that the eviction process complied with legal procedures and proper protocols were followed. The allegation was determined to be unfounded and dismissed after interviews, observations, and record reviews.
Report Facts
Facility capacity: 232
Census: 106
Complaint receipt date: Feb 6, 2025
Eviction notice date: Sep 25, 2024
Court eviction approval date: Jan 7, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Armando Perez | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Molly Bowie | Executive Director | Facility administrator interviewed during investigation |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Capacity: 232
Deficiencies: 0
Date: Jan 16, 2025
Visit Reason
The visit was an unannounced complaint investigation regarding an allegation that staff were not allowing a resident to return to the facility due to their stage 4 pressure injury.
Complaint Details
The complaint alleged that staff were not allowing a resident to return to the facility due to their stage 4 pressure injury. The allegation was investigated and found to be unfounded.
Findings
Based on interviews, observations, and record review, the allegation was found to be unfounded. The resident was not denied return but was registered for hospice care for the stage 4 pressure injury.
Report Facts
Facility capacity: 232
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Armando Perez | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Molly Bowie | Administrator | Provided information regarding level of care for stage 4 pressure injury |
| Crystal Maldonado | Business Office Manager | Met with Licensing Program Analyst during the investigation and received the report |
| Jazmond D Harris | Licensing Program Manager | Named in report signature section |
Inspection Report
Complaint Investigation
Census: 98
Capacity: 232
Deficiencies: 0
Date: Nov 18, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation regarding 'Personal Rights' at the facility.
Complaint Details
The complaint alleging 'Personal Rights' was investigated and found to be unfounded, meaning the allegation was false, could not have happened, and/or was without a reasonable basis.
Findings
The investigation found the complaint to be unfounded after a review of records and interviews confirmed the alleged resident was not admitted to this facility but to a different licensed residential care facility for the elderly.
Report Facts
Capacity: 232
Census: 98
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sara Martinez | Licensing Program Analyst | Conducted the complaint investigation |
| Molly Bowie | Executive Director | Met with Licensing Program Analyst during investigation and provided information about the allegation |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 232
Deficiencies: 0
Date: Oct 23, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that facility staff were not properly addressing pest infestation in the facility.
Complaint Details
The complaint alleged that facility staff were not properly addressing pest infestation, specifically bugs and mice in a resident's room. The investigation found the allegation to be false and without reasonable basis.
Findings
The investigation found the complaint to be unfounded. No evidence of pest infestation was observed or reported by residents, staff, or pest control services. The facility has an ongoing contract with a pest control company providing routine treatments.
Report Facts
Capacity: 232
Census: 103
Residents interviewed: 5
Staff interviewed: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Molly Bowie | Administrator | Met with Licensing Program Analyst during the investigation and provided information about pest control services |
| Janette Romero | Licensing Program Analyst | Conducted the complaint investigation visit |
| Tricia Danielson | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 105
Capacity: 232
Deficiencies: 0
Date: Oct 2, 2024
Visit Reason
The inspection was an unannounced complaint investigation regarding an allegation that staff spoke inappropriately to a resident.
Complaint Details
The complaint alleged that a staff member yelled and threatened Resident One in the facility courtyard. Interviews with the resident, staff involved, and witnesses did not confirm the allegation. The complaint was unsubstantiated.
Findings
The investigation found no preponderance of evidence to substantiate the allegation that staff yelled at or threatened the resident; the allegation was determined to be unsubstantiated after interviews with the resident, staff, and other residents.
Report Facts
Capacity: 232
Census: 105
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sara Martinez | Licensing Program Analyst | Conducted the complaint investigation |
| Molly Bowie | Executive Director | Facility representative met during the investigation |
| Tricia Danielson | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 100
Capacity: 232
Deficiencies: 1
Date: Sep 16, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff did not release resident records upon request from the resident's authorized person.
Complaint Details
The complaint was substantiated. The allegation was that staff did not release resident records upon request from the resident's authorized person. The investigation confirmed that requested documents were not provided to the authorized representative as required.
Findings
The investigation found that the facility did not provide requested records for Resident One to the authorized representative in a timely manner, violating regulations requiring prompt access to records. The allegation was substantiated based on interviews and records review.
Deficiencies (1)
Failure to provide Resident One's requested records to the authorized representative within two business days as required by CCR 87468.2(a)(19).
Report Facts
Capacity: 232
Census: 100
Plan of Correction Due Date: Sep 27, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sara Martinez | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Molly Bowie | Executive Director | Facility representative involved in the investigation and exit interview |
| Tricia Danielson | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 84
Capacity: 232
Deficiencies: 0
Date: Jul 17, 2024
Visit Reason
An unannounced complaint investigation was conducted regarding an allegation that the licensee was not properly addressing a pest issue in the facility, specifically involving rats, termites, and cockroaches.
Complaint Details
The complaint alleged that the licensee was not properly addressing pest issues, including rats, termites, and cockroaches. The complaint was found to be unfounded based on interviews, record reviews, and pest control service documentation.
Findings
The investigation found that the licensee had a current contract with a local exterminator company providing regular pest control services, including treatment for bed bugs and cockroaches. No evidence was found to support the presence of termites or rats, and the allegation was determined to be unfounded.
Report Facts
Facility capacity: 232
Census: 84
Pest control visits: 13
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the complaint investigation |
| Molly Bowie | Executive Director | Interviewed during the investigation |
| Tricia Danielson | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 232
Deficiencies: 0
Date: May 29, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that staff were retaliating against a resident and refusing to accept the resident's rent money.
Complaint Details
The complaint alleged staff retaliation against Resident #1 and refusal to accept the resident's rent money. The investigation found that the facility had issued an eviction notice and handled rent payments and refunds appropriately. The resident refused to sign new contracts after a change in ownership. The allegations were unsubstantiated due to lack of preponderance of evidence.
Findings
The investigation included observations, interviews, and records review. Both allegations were found to be unsubstantiated based on the evidence gathered, including rent payment records and interviews with the Executive Director and the resident.
Report Facts
Facility capacity: 232
Census: 91
Complaint receipt date: May 22, 2024
Eviction notice date: Jan 19, 2024
Demurrer dismissal date: Apr 16, 2024
Notice date: Oct 1, 2023
Rent charge amount: 4500
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Morgan Williams | Executive Director | Interviewed regarding allegations and investigation findings |
| Javina George | Licensing Program Analyst | Conducted the complaint investigation visit |
| Tricia Danielson | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Original Licensing
Census: 73
Capacity: 236
Deficiencies: 2
Date: Mar 14, 2024
Visit Reason
The inspection visit was conducted as a Pre-Licensing visit for Change of Ownership to evaluate the facility prior to issuing a new license.
Findings
The facility was generally found to be in good condition with adequate emergency preparedness, food service, and medication storage. However, corrections were required for trash bins in resident bedrooms lacking tight-fitting lids and water temperatures below 105 degrees in multiple resident bedrooms.
Deficiencies (2)
Trash bins in resident bedrooms were not observed to have tight-fitting lids
Water temperature was reading below 105 degrees in multiple resident bedrooms
Report Facts
Fire Clearance capacity: 232
Water temperature readings: 86
Water temperature readings: 108.5
Water temperature readings: 103.6
Water temperature readings: 106.5
Water temperature readings: 90.3
Water temperature readings: 107.7
Water temperature readings: 109
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Morgan Williams | Administrator | Met with Licensing Program Analyst during Pre-Licensing visit and named in relation to findings |
| Adam Zenou | Applicant | Met with Licensing Program Analyst during Pre-Licensing visit |
| Crystal Colvin | Licensing Program Analyst | Conducted the Pre-Licensing visit and authored the report |
| Tricia Danielson | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Census: 150
Capacity: 236
Deficiencies: 0
Date: Feb 27, 2024
Visit Reason
The visit was an office evaluation conducted virtually via Microsoft Teams to assess the applicant/administrator's understanding of community care facility licensing laws and readiness for licensing.
Findings
The applicant and administrator demonstrated understanding of facility operation, admission policies, staffing requirements and training, restrictive/prohibited health conditions, general provisions, emergency preparedness, complaints and reporting, and pre-licensing readiness. Signed documentation and identification were verified.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Morgan Williams | Administrator | Participated in COMP II and confirmed understanding of licensing laws. |
| Adam Zenou | Corporate Board Member | Participated in COMP II. |
| Darla Neeley | Licensing Program Manager | Named as Licensing Program Manager on report. |
| Diamond Law | Licensing Program Analyst | Named as Licensing Program Analyst on report. |
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