336426511-2-22-2023-56-AS-EMAN-CS4MJT-20230523093936

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 02/22/2023
Date Signed: 02/22/2023 02:02:30 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
02/17/2023 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230217143828

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: 115	DATE:	02/22/2023
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Alexis Brown- Health Services Director		TIME COMPLETED:	02:12 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident timely.
Staff do not address residents change in condition.
Staff do not respond to residents call pendant.
Staff do not assist resident with incontinence needs timely.
Staff do not assist resident with bathing.
Staff do not remove discarded foods from resident's room timely.
Staff did not ensure facility was free from insects.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to investigate and deliver findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Health Services Director Alexis Brown.

During today’s visit, LPA toured the facility, conducted interviews with staff, conducted interviews with residents, and reviewed facility documents.

For allegation, Staff did not seek medical attention for resident timely:

During interviews conducted with staff, LPA discovered that when a resident needs medical attention the care staff immediately calls for a medical technician staff. If further medical evaluation is necessary, the facility staff immediately calls 911 for medical attention.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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 56-AS-20230217143828

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: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 02/22/2023

NARRATIVE

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During interviews conducted with residents, LPA discovered that the residents found that the facility is quick to respond to their medical attention needs. There were no concerns with the facility not being responsive to their medical needs.

During document review, LPA reviewed the facilities recent reports to State Licensing and found that the facility is reporting that medical attention was sought out in a timely manner.

For allegation, Staff do not address residents change in condition.

During interviews conducted with staff, if a resident has a change in condition, the change is immediately reported to the Health Services Director and the Resident Care Coordinator. The Health Services Director and the Resident Care Coordinator immediately updates the residents file and care plan with the change in condition to ensure the proper care starts right away.

For allegation, Staff do not respond to residents call pendant:

During interviews conducted with staff, LPA discovered that the care staff does respond to resident’s call pendants. The amount of time it takes for a care staff to respond to a resident pendant call averages five (5) to fifteen (15) minutes. The response time depends on how many residents require care at the same time.

During interviews conducted with residents, LPA discovered that most of the residents reported that care staff responds to their pendant calls immediately. Other residents reported that the care staff responds to their pendant calls within fifteen (15) minutes.

During document review, LPA discovered the majority of the resident pendant calls were responded to within fifteen (15) minutes. There were some instances of a longer response time, but during review staff noted that the longer response times were not actually response times, but extra time to reset a residents call pendant when they do not reset on their own.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 56-AS-20230217143828

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: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 02/22/2023

NARRATIVE

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For allegation, Staff do not assist resident with incontinence needs timely:

During interviews conducted with staff, LPA was informed that the facility has a “Residents on Care Schedule”. The schedule notates which residents need incontinence care. LPA discovered that staff assist the residents with incontinence needs every one (1) to two (2) hours throughout the morning, day, and evening shifts. If a resident needs more assistance than the one (1) to two (2) hour checks, the resident can press their call pendant to receive more assistance. The residents are sleeping during NOC shift (night shift), during this time the resident’s incontinence needs are met on a as needed basis by resident pendant calls.

During interviews conducted with residents, LPA discovered that the residents do not have any issues or concerns about the staff not assisting them with their incontinence needs in a timely manner. LPA did not encounter a resident that had complaints of being left in a soiled diaper for an extended period to time.

During document review, LPA reviewed the facilities “Residents on Care Schedule”. The schedule notates which residents need incontinence care. The facility uses this document to ensure the residents on the list are checked on the appropriate number of times throughout the day/night.

For allegation, Staff do not assist resident with bathing:

During interviews conducted with staff, LPA was informed that the facility has a “Residents on Care Schedule”. The schedule notates which residents need bathing assistance. In addition, the staff follows a shower schedule that notates what days each resident is assisted with bathing. If a resident refuses bathing, a shower refusal slip is filed out and signed by the resident notating the reason for not accepting bathing assistance. LPA was informed that prior to filing out a shower refusal slip the resident speaks to two (2) care staff to verify the resident is sure they want to refuse bathing assistance. It is the residents personal right to refuse a shower if they do not want one. The facility will document the refusal and attempt to bathe the resident on their next scheduled shower.

During interviews conducted with residents, LPA discovered that the residents do not have any issues or concerns about the staff not assisting them with bathing. LPA did not encounter a resident that had complaints of not being provided bathing assistance.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 56-AS-20230217143828

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: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 02/22/2023

NARRATIVE

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During document review, LPA reviewed the facilities “Residents on Care Schedule”. The schedule notates which residents need shower assistance. LPA also reviewed the facility shower schedule and an example of a shower refusal slip.

For allegation, Staff do not remove discarded foods from resident’s room timely:

During interviews conducted with staff, LPA discovered that the food brought into the resident’s rooms is discarded within one (1) to four (4) hours of a resident receiving a meal. This gives the resident time to eat their meal and decide if they want to save part of the meal for later. The portion of the meal that needs to be discarded is either removed by kitchen staff when they bring the next meal of the day or when care staff is doing resident room checks. There is never time when residents’ food is not discarded from the resident’s rooms.

During interviews conducted with residents, LPA discovered that the resident’s did not have any concerns or issues with food being removed from their rooms.

For allegation, Staff did not ensure facility was free from insects:

During interviews conducted with staff, LPA discovered that Western Exterminator Company treats the facility for pests and insects on a monthly basis. If a resident has pests in their room, the facility ensures that the resident’s room is treated until the issue is resolved. LPA was not informed of any areas within the facility where insects or pests were present.

During interviews conducted with residents, LPA was not informed of any areas within the facility where there were insects and pests present.

During document review, LPA reviewed Western Exterminator invoices for December 2022 and January 2023. LPA discovered that the facility is ensuring the facility is free of pests and insects by having monthly pest control treatment completed.

During facility tour, LPA toured the main areas, hallways, offices, resident bedrooms, the dining area, and the kitchen. During the tour, LPA did not observe any insects or pests.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 56-AS-20230217143828

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: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 02/22/2023

NARRATIVE

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Based on evidence obtained during today’s visit, the seven (7) allegations listed above are 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 (LIC9099) was discussed and provided to Health Services Director Alexis Brown, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

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