336423880-3-7-2023-18-AS-KCLS-CQ4P8C-20230320110520

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336423880
Report Date: 03/07/2023
Date Signed: 03/07/2023 01:24:23 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/24/2021 and conducted by Evaluator Rayshaun Nickolas

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210224084519

FACILITY NAME:	VISTA COVE AT CORONA		FACILITY NUMBER:	336423880
ADMINISTRATOR:	ALEJANDRA PERDOMO		FACILITY TYPE:	740
ADDRESS:	2600 SOUTH MAIN STREET		TELEPHONE:	(951) 736-4780
CITY:	CORONA	STATE: CA	ZIP CODE:	92882
CAPACITY:	49	CENSUS: 11	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Courtney Barreto, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident developed pressure injuries while in care
Facility is in disrepair
Facility staff is not properly trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to deliver the finding on the above allegations. LPA met with Administrator Courtney Barreto and explained the purpose of the visit. The investigation included file reviews, a tour of the facility, and interviews with relevant parties.

Allegation #1 “Resident developed pressure injuries while in care”. The reporting party (RP) alleged that resident #1 (R1) had pressure injuries when moved out of the facility. LPA interview with the administrator revealed that R1 did not have pressure injuries when they moved out of the facility. LPA interview with staff # 1 (S1) revealed that R1 did not have pressure injuries. LPA facility file review of R1’s records revealed no evidence that R1 had pressure injuries. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #2 "Facility is in disrepair". The RP alleged that the kitchen sink in R1's room was leaking and had a puddle of brown/black liquid about 6" inches in diameter" under the kitchen sink.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20210224084519

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: VISTA COVE AT CORONA	FACILITY NUMBER: 336423880
	VISIT DATE: 03/07/2023

NARRATIVE

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LPA interviews with facility staff revealed that the facility staff denied that the kitchen sink in R1's room was leaking and had a puddle of brown/black liquid under the sink. On 03/07/2023, LPA conducted a tour of the facility, including looking under the sinks in several residents' rooms, including R1's former room. LPA observed no leaks under any sinks (kitchen and bathroom) in the residents' room. LPA cannot attest to the facility's state when this allegation was made; therefore, the finding is unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation # 3 “Facility staff is not properly trained”. The RP alleged that an unknown staff member has no medical field training and is handling medication as a med tech. LPA interview with the administrator revealed that the staff's initial training includes 16 hours of on-the-job medication training. Per the administrator, the 16 hours include eight (8) hours of new hires shadowing the administrator or experienced med tech. LPA interview with the administrator revealed that during the eight (8) hours, the trainee would watch the med tech or administrator pop medication from the bubble pack, order medications, dispose of old bubble packs, and watch how to administer medication to the residents. LPA interview with the administrator also revealed that after the trainee has completed eight (8) hours of watching their trainer (administrator or experienced med tech), the trainee will receive eight (8) hours of hands-on training with a trainer present. LPA interview with the administrator revealed that in addition to the 16 hours of on-the-job training, there are also 20 hours of bookwork, watching videos, readings, and examinations to complete. LPA interview with the administrator further revealed that the 16 hours of on-the-job training is completed after the 20 hours of bookwork, watching videos, reading, and examinations are completed. LPA facility file review of staff employed at the facility when this allegation was made revealed that staff did receive training on handling medication. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of 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.

An exit interview was conducted and copy of this report was provided.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

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