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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880546
Report Date: 04/23/2025
Date Signed: 04/23/2025 12:20:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/07/2023 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231107145012
FACILITY NAME:ESTANCIA DEL SOLFACILITY NUMBER:
331880546
ADMINISTRATOR:LISA HUNTFACILITY TYPE:
740
ADDRESS:2489 CALIFORNIA AVETELEPHONE:
(951) 268-9697
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:135CENSUS: 124DATE:
04/23/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Lisa HuntTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Facility staff did not dispense medication as prescribed resulting in hospitalization.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to deliver findings for the allegation listed above.LPA met Administrator Lisa Hunt and explained the purpose of the visit. The investigation consisted of resident interviews, staff interviews, facility document review, and medical document review.

For the allegation, Facility staff did not dispense medication as prescribed resulting in hospitalization.

Resident #1 (R1) suffered a stroke due to inaccurate medication dosage.
The investigation was conducted by Community Care Licesning Investigation Branch.Interviews with the staff and document review revealed that Resident R1 has been on a medication, which requires a monthly dosage adjustment based on R1’s blood work results. It was revealed that on 6/28/2023 Staff S1 received a phone call from a medical provider staff to verbally inform S1 of an adjusted dosage amount for R1’s medication. During the shift change, S1 verbally informed Staff S2 of R1’s medication dosage adjustment.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/07/2023 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231107145012

FACILITY NAME:ESTANCIA DEL SOLFACILITY NUMBER:
331880546
ADMINISTRATOR:LISA HUNTFACILITY TYPE:
740
ADDRESS:2489 CALIFORNIA AVETELEPHONE:
(951) 268-9697
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:135CENSUS: 124DATE:
04/23/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Lisa HuntTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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2
3
4
5
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8
9
Facility staff did not address change in resident's condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to deliver findings for the allegation listed above. LPA met with Administrator Lisa Hunt and explained the purpose of the visit. The investigation consisted of resident interviews, staff interviews, facility document review, and medical document review.

For allegation, Facility staff failed to observe Resident #1’s (R1) change in condition.

The investigation was conducted by Community Care Licesning Investigation Branch. Interviews with staff and document review revealed that on 6/28/2023 Staff S3 completed a resident check on R1 between 8:30 AM and 8:45 AM. During this resident check, S3 did not report any change of condition for R1. At 9:22 AM S3 received a text message from Family Member F1 asking the facility staff to complete a resident check on R1. F1 had a verbal conversation with R1 and believed R1 had a stroke. When S3 arrived to R1’s bedroom, R1’s face had dropped on one (1) side and R1’s speech was slurred. During the resident check, S3 called 911 for R1 to receive medical attention.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20231107145012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ESTANCIA DEL SOL
FACILITY NUMBER: 331880546
VISIT DATE: 04/23/2025
NARRATIVE
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The facility staff failed to observe R1’s change of condition when they were in R1’s bedroom completing the resident check between 8:30 AM and 8:45 AM.

Based on the evidence discovered during the investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because of the preponderance of evidence the standard has been met.

During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and LIC9099D were discussed and provided to Administrator Lisa Hunt, along with a copy of the appeal rights.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20231107145012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ESTANCIA DEL SOL
FACILITY NUMBER: 331880546
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
04/24/2025
Section Cited
CCR
87468.2(a)(8)
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87468.2(a) Additional Personal Rights of Residents in Privately Operated Facilities (a). the rights listed..Personal Rights.. residents in privately operated residential care facilities.. elderly..following personal rights:(8) To be free from neglect.. involuntary seclusion,..
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The licensee has agreed to conduct a resident change in condition training that includes resident check procedures with the staff and send LPA proof of attendance.
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This requirement is not met as evidenced based on interview and document review, the licensee did not comply with the section cited above evidenced by failing to observe a change in condition for R1 which poses an immediate health, safety, or personal rights risk to persons in care.
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POC due date 4/24/2025
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20231107145012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ESTANCIA DEL SOL
FACILITY NUMBER: 331880546
VISIT DATE: 04/23/2025
NARRATIVE
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On 6/28/2023, S2 administered R1’s medication incorrectly. R1’s medication was supposed to be lowered to half of the normal dosage, but instead S2 increased R1’s dosage three (3) times the prescribed amount. Thirty-six (36) hours later R1 suffered a stroke and was transported to receive medical care. Based upon investigation, medication documentation did not substantiate that R1 stroke was due to the inaccurate medication dosage.

The allegation listed above is deemed UNSUBSTANTIATED.



A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation 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 was discussed and provided to Administrator Lisa Hunt.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5