336426511-11-1-2022-56-AS-EMAN-CLNQ7Z-20221130105559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 11/01/2022
Date Signed: 11/01/2022 12:17:51 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
10/26/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221026090316

FACILITY NAME:	AVISTA SENIOR LIVING MAGNOLIA		FACILITY NUMBER:	336426511
ADMINISTRATOR:	BLASIA LEE-LOLE		FACILITY TYPE:	740
ADDRESS:	737 MAGNOLIA AVE		TELEPHONE:	(951) 737-1600
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	180	CENSUS: 125	DATE:	11/01/2022
		UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Alexis Brown- Health Services Director		TIME COMPLETED:	12:27 PM

ALLEGATION(S):

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Staff does not properly prepare food for residents.
Staff are not providing residents with food of good quality.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Ryan Gardner and Paola Guerrero conducted an unannounced visit to the facility for the purpose of initiating an investigation and delivering findings for the above complaint allegations. LPAs met with Health Services Director Alexis Brown and explained the reason for the visit.

During today’s visit, LPAs toured the kitchen, interviewed staff members, and interviewed residents.

For allegation, Staff does not properly prepare food for residents:

LPAs interviewed nine (9) residents and five (5) staff. During interviews conducted with residents, LPAs found that seven (7) out nine (9) residents stated the food served at the facility is prepared properly. During interviews conducted with facility staff, LPAs found that five (5) out of five (5) staff stated the food at the facility was prepared properly. LPAs were not given information to collaborate the above allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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 56-AS-20221026090316

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: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 11/01/2022

NARRATIVE

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For allegation, Staff are not providing residents with food of good quality:

LPAs interviewed nine (9) residents and five (5) staff. During interviews conducted with residents, LPAs found that nine (9) out nine (9) residents stated the food served at the facility is good quality. During interviews conducted with facility staff, LPAs found that five (5) out of five (5) staff stated the food served at the facility is good quality. The residents are served breakfast, lunch, dinner, and snacks throughout the day. The residents are served protein, fruit, and vegetables. LPAs were provided a copy of the weekly menu showing the planned meal options. LPAs were not given information to collaborate the above allegation.

Based on the information found and provided, the allegations listed above are deemed UNSUBSTANTIATED.

A finding that the complaint is UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations listed are deemed unsubstantiated.

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 Health Services Director Alexis Brown, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

LIC9099 (FAS) - (06/04)

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