336426511-5-31-2023-56-AS-EMAN-CSCV28-20230531160240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 05/31/2023
Date Signed: 05/31/2023 09:16:42 AM

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
04/11/2022 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220411153553

FACILITY NAME:	AVISTA SENIOR LIVING MAGNOLIA		FACILITY NUMBER:	336426511
ADMINISTRATOR:	MONIQUE DEL JUNCO		FACILITY TYPE:	740
ADDRESS:	737 MAGNOLIA AVE		TELEPHONE:	(951) 737-1600
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	180	CENSUS: 122	DATE:	05/31/2023
		ANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Executive Director Blasia Lee-Lole		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Questionable death.
Staff did not seek timely medical attention for resident.
Staff smokes marijuana inside facility.

INVESTIGATION FINDINGS:

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On 05/31/2023 at 08:50 AM, Licensing Program Analyst (LPA) Melody Brown met with Executive Director Blasia Lee-Lole at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegations. LPA Brown explained the purpose of the Office Visit. The investigation consisted of file review, interviews with staff and residents as well as observation.

The investigation was conducted by LPA Brown. The investigation consisted of file review and interviews with relevant parties. The first allegation indicates Questionable death. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Staffs interviews indicated that Resident #1 (R1) passed away while sleeping. LPA Brown reviewed R1’s death certificate that stated primary cause of death was heart condition. Interview with R1's family indicated that they did not suspect that the facility hastened the death of their family member and maintains that R1 died of natural causes.
***Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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-20220411153553

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: 05/31/2023

NARRATIVE

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The second allegation alleges that Staff did not seek timely medical attention for resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with staffs and residents indicated that staffs are seeking timely medical attention for residents and no incident happened at the facility that a staff did not seek timely medical attention for resident. Interview with R1's family indicated that staffs seek timely medical attention for residents.

The third allegation indicates Staff smokes marijuana inside facility. Residents’ interviews indicated that they did not see a staff smoking marijuana inside the facility and they added that smoking inside the facility is not allowed, and no incident happened at the facility that a staff smoke marijuana inside the facility. Staffs’ interviews revealed no staff are smoking marijuana inside the facility and no incident happened at the facility that a staff was seen smoking marijuana.

Based on interviews and records review, the allegation Questionable death (Allegation #1), Staff did not seek timely medical attention for resident (Allegation #2), Staff smokes marijuana inside facility (Allegation #3) are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, where this report, (LIC9099) was discussed and provided to Executive Director Blasia Lee-Lole.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC9099 (FAS) - (06/04)

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