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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 04/25/2025
Date Signed: 04/25/2025 03:58:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
04/11/2025 and conducted by Evaluator Raquel Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250411085710
FACILITY NAME:VISTA CORONA SENIOR LIVINGFACILITY NUMBER:
336426511
ADMINISTRATOR:BLASIA LEE-LOLEFACILITY TYPE:
740
ADDRESS:737 MAGNOLIA AVETELEPHONE:
(951) 737-1600
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:180CENSUS: 103DATE:
04/25/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Andrea PerezTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff are not assisting residents calls for assistance timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Administrator Andrea Perez and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and document review.

For the allegation, Staff are not assisting residents calls for assistance timely.

LPA Hernandez conducted (8) resident interviews. 7 out of the 8 stated facility staff do not assist them in a timely manner. Additionally, LPA Hernandez requested residents to push their pendant and waited for staff to arrive. LPA Hernandez observed staff taking ten minutes to answer Resident #5 (R5) pendant. Also, LPA Hernandez requested Resident #7 (R7) to push their pendant and observed it taking eighteen minutes for staff to answer R7's pendant.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
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 5
Control Number 56-AS-20250411085710
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VISTA CORONA SENIOR LIVING
FACILITY NUMBER: 336426511
VISIT DATE: 04/25/2025
NARRATIVE
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Based on the evidence gathered during the investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence the standard has been met.

An exit interview was conducted and the forms LIC9099 and LIC9099D were discussed and left with Administrator Andrea Perez along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
04/11/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20250411085710

FACILITY NAME:VISTA CORONA SENIOR LIVINGFACILITY NUMBER:
336426511
ADMINISTRATOR:BLASIA LEE-LOLEFACILITY TYPE:
740
ADDRESS:737 MAGNOLIA AVETELEPHONE:
(951) 737-1600
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:180CENSUS: 103DATE:
04/25/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Andrea PerezTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff are violating residents rights
Food quality/quantity is not sufficient
Staff do not follow resident(s) special diets.
Staff did not ensure the resident's wheelchair wheels were lined up correctly exiting the facility van which resulted in injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Andrea Perez and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and document review.

For the allegation, Staff are violating residents rights

LPA Hernandez conducted (8) resident interviews. Based on resident interviews there was not enough evidence to corroborate personal rights of residents in care are being violated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 56-AS-20250411085710
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VISTA CORONA SENIOR LIVING
FACILITY NUMBER: 336426511
VISIT DATE: 04/25/2025
NARRATIVE
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For the allegation, Food quality/quantity is not sufficient

LPA Hernandez toured facility kitchen and observed appropriate food service available to residents in care. LPA Hernandez observed food menu as well an adequate amount of food being available to residents in care. LPA Hernandez conducted (5) staff interviews. 5 out of the 5 indicated that if food quantity is not sufficient additional food is offered to residents in care.

For the allegation, Staff do not follow resident(s) special diets.

LPA Hernandez observed special dieting food menus available for residents in care. Additionally, LPA Hernandez spoke with Staff #2 (S2) who stated residents are offered food options as well as snacks throughout the day who contain special dieting needs.

For the allegation, Staff did not ensure the resident's wheelchair wheels were lined up correctly exiting the facility van which resulted in injury.

LPA Hernandez spoke with Administrator Andrea Perez who stated Resident #4 (R4) fell out of motorized scooter due to R4 attempting to exit van. LPA Hernandez spoke with Staff #3 (S3) who stated R4 fell out of motorized scooter due to R4 attempting to exit van on a high functioning speed level which lead to R4 falling. S3 stated R4 was assisted and hospital services were offered, however, R4 denied hospital services.

Based on the evidence gathered during today’s investigation, the allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and this form LIC9099 was discussed and left with Administrator Andrea Perez.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20250411085710
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VISTA CORONA SENIOR LIVING
FACILITY NUMBER: 336426511
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/28/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) ...The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided.. This requirement was not met as evidenced by:
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LPA Hernandez discussed with Administrator about hiring additional staff and requested LIC500 to be sent to licensing department by Plan of Correction (POC) due date.
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Based on observation and interviews, the licensee did not comply with section cited above by not ensuring residents in care are provided assistance in a timely manner, which poses an immediate health, safety, and personal rights risk to those in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5