336423880-5-16-2023-56-AS-KCLS-CRY4HH-20230518190710

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336423880
Report Date: 05/16/2023
Date Signed: 05/16/2023 12:22:12 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
08/19/2022 and conducted by Evaluator Rayshaun Nickolas

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220819125545

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: 12	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Courtney Barreto, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility has mold.
Facility storing expired food.
Facility has insects.
Facility kitchen and/or dining area is inaccessible to resident's.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Administrator Courtney Barreto and explained the purpose of the visit. These allegations were investigated by department staff, and during today’s visit, LPA Nickolas conducted additional interviews with relevant parties and a facility tour.

Allegation #1 “Facility has mold”. The allegation alleged that the facility’s kitchen has mold. Department staff showed the Administrator a picture taken by a representative of an outside agency during the interview, and the Administrator agreed that mold had developed in the cupboards due to a leak. The Administrator stated that actions were taken to resolve the issue. Department staff interviews with residents in care revealed that no clients witnessed or admitted to observing mold in the facility. LPA Nickolas’ interview with the Administrator revealed a bad leak in the kitchen. The Administrator stated that they observed something near the bottom of the cabinet. However, the Administrator was unsure if it was mold because it was never tested.

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: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20220819125545

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: 05/16/2023

NARRATIVE

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LPA Nickolas' interviews with facility staff members revealed observing mold due to a leak in the kitchen; however, the cabinets were removed, and the issue was resolved. During today's visit, LPA Nickolas' observed no mold in the facility's kitchenette. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #2 “Facility storing expired food”. The allegation alleged bad food on the shelves, refrigerator, and freezer. Department staff interview with the Administrator revealed that all food is prepared in the other building (the Skilled Nursing Facility), also located on the premises. The department staff facility tour revealed no expired food in the facility’s kitchen. LPA Nickolas’ interview with the Administrator revealed that the Administrator denied the facility is storing expired food. LPA Nickolas' interviews with facility staff members revealed that they denied observing expired food stored at the facility. During today’s visit, LPA Nickolas' observed no expired food stored in the central kitchen in the Skilled Nursing Facility next door. LPA Nickolas' also observed no expired food stored in the kitchenette located in the facility. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #3 “Facility has insects”. Department staff interview with the Administrator revealed that the facility had an ongoing issue of mosquitos secondary to the pipe that burst in the dining area. The Administrator stated that the facility had contracted Orkin pests’ services to eliminate the insects. Department staff noted mosquitos in most of the rooms during their initial visit. Department staff interview with resident # 1 (R1) revealed that the facility had a problem with mosquitos. Department staff interview with resident # 3 (R3) revealed that the facility had many mosquitos. Department staff interview with resident #4 (R4) revealed that there might be a bug or two (2) but not a bug problem. Department staff interview with resident #5 (R5) revealed a problem with mosquitos due to the pipe that had burst in the dining area; however, the facility is working on fixing the problem. Department staff interview with resident #6 (R6) revealed too many insects. R6 also stated that it was probably due to the pipe that had burst in the dining area. LPA Nickolas’ interview with the Administrator revealed that the facility has a contract with Orkin, which services the building once or twice a month. During today’s visit, LPA Nickolas observed two (2) Orkin electric bug zappers in the facility hall, which the administrator confirmed that the Orkin technician had installed. LPA Nickolas’ also observed two (2) mosquitos in the facility's lobby; however, the mosquitos flew inside the facility when individuals entered or exited the facility. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20220819125545

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: 05/16/2023

NARRATIVE

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Allegation #4 “Facility kitchen and/or dining area is inaccessible to resident's”. The allegation alleged that the facility blocked the resident from entering the kitchen/ dining area. The allegation alleged that the residents were upset because they missed social dining. Department staff interview with the Administrator revealed a pipe leak in the kitchen area of the dining area. The Administrator stated that they had informed all the residents about the leak and that extensive repairs were required. The Administrator stated that dinner services were promptly moved to the activities room to maintain a social aspect of mealtime. LPA Nickolas’ interview with the Administrator revealed that the residents were temporarily moved to the activities room during the initial stages of the construction for a month or two (2). 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: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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