336426511-5-19-2023-56-AS-EMAN-CT8LVZ-20230628090619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 05/19/2023
Date Signed: 05/19/2023 03:21:22 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
05/15/2023 and conducted by Evaluator Victoria Chitgian

COMPLAINT CONTROL NUMBER: 56-AS-20230515165039

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:	DATE:	05/19/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:			TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff yell at resident in care.
Staff does not provide adequate food service to resident.
Staff does not ensure facility has adequate food supplies.
Facility has mold.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Chitgian conducted an unannounced visit to the facility to investigate and deliver findings for the above allegations. LPA met with Executive Director Blasia Lee-Lole and explained the purpose of today’s visit. Investigation consisted of interviews with pertinent parties, observations and records review.
The first allegation indicates Staff yell at resident in care. During interviews conducted with staff, LPA discovered there have not been any reported complaints regarding staff making inappropriate comments to residents. The staff all stated that the interactions with the residents are positive and respectful. The only reason a staff might raise their voice during a conversation with a resident is to ensure the resident can hear them.
The second allegation indicates Staff does not provide adequate food service to resident. Based on observations, LPA witnessed the dining room during lunchtime, between 11:30am-2:00pm. Food service provided was observed to ensure enough time was allocated to consume the meal. Interviews with staff and clients indicate that residents are allowed plentiful time to consume their meals.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Victoria Chitgian	TELEPHONE: (951) 248-0306
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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-20230515165039

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: 05/19/2023

NARRATIVE

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Residents receiving food tray service in their rooms are served first. Interviews with residents and staff also indicated that they are not rushed, nor are rushing anyone out of the dining room.

The third allegation indicates Staff does not ensure facility has adequate food supplies. Based on interviews and observations, the dining room has a new head chef since March 2023. Per Interviews with residents and staff, there have been improvements in the food quantities, quality and taste. LPA observed the kitchen refrigerators to be fully stocked with proteins, starches, fruits, vegetables and non-perishables in large quantities. Interview with staff indicate they have options for all the diet-needs of the residents, including sugar-free deserts, low-sodium options, and heart-healthy varieties. Interviews also indicate food is purchased bi-weekly.

The fourth allegation indicates Facility has mold. Based on records review, LPA received copies of pertinent documents and photographs of past work orders for air conditioner damage, resulting in mold. Facility addressed the mold by hiring a contractor. Start date on record indicated 3/9/2023, completed on 3/14/2023. LPA observed the physical location of the past damage and noted it to be corrected.

During review of records and interview with administrator, LPA discovered the facility does not have a resident by the name indicated on the LIC 802. Resident 1 has not, and does not live at the facility, nor is associated to the facility as stated.

Based on the information obtained, LPA has determined the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted, and a copy of this report (LIC 9099) provided to Executive Director Blasia Lee-Lole.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Victoria Chitgian	TELEPHONE: (951) 248-0306
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC9099 (FAS) - (06/04)

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