336426511-7-10-2023-56-AS-EMAN-CUWMVH-20230821095646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 07/10/2023
Date Signed: 07/10/2023 02:17:46 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
07/03/2023 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230703113153

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: 118	DATE:	07/10/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Blasia Lee-Lole- Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff failed to treat resident with dignity and respect.
Facility has mold.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to investigate and issue findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Administrator Blasia Lee-Lole. The visit today consisted of a facility tour, interviews with residents and staff, and document review.

For allegation, Staff failed to treat resident with dignity and respect:

During interviews with residents, the residents explained that the staff is very nice and treats them fairly. The residents stated that the staff does not yell at them or make inappropriate comments towards them. The residents feel like they are treated with dignity and respect.

During interviews with staff, the staff denied yelling at the residents and denied making inappropriate comments towards the residents.

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: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

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-20230703113153

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: 07/10/2023

NARRATIVE

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The staff stated that the only time they would raise their voice to resident is when the resident has a hard time hearing and needs to be talked to in a louder tone. The staff stated that if a resident gets upset and yells at them, the staff doesn’t not respond in the same demeanor. The staff will try to calm the resident down in a pleasant manner and give the resident time and space if needed to work out any issues that arise.

For allegation, Facility has mold:

During document review, LPA reviewed statements and an estimate of repair work for a water pipe leak that started in basement of the facility in January of 2023. LPA also reviewed a statement for a leak that occurred in the underground parking lot on 7/5/2023.

During the facility tour, LPA was shown areas in the basement and parking lot where the water leaks occurred. LPA was shown areas of the walls and the ceiling that still need to be repaired. The areas that need to be repaired are in the basement area near the salon and the break room, as well as the ceiling in underground parking lot.

During interviews with staff, LPA discovered that multiple companies have come to repair the water leaks, but as more companies come out, more issues have been found during the process. LPA was informed that the facility currently is waiting on company approval of a construction estimate to repair the damages the water leaks created. Once the estimate is approved, the facility will repair the walls, ceilings, and all other areas affected by the water leaks. LPA was informed that the facility will notify state licensing when all the repairs are complete.

Based on evidence obtained during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are 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.

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 Administrator Blasia Lee-Lole, 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: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

LIC9099 (FAS) - (06/04)

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