336426511-7-8-2025-56-AS-EMAN-DJWPZQ-20250725114555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 07/08/2025
Date Signed: 07/08/2025 12:58:53 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
11/14/2023 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231114083849

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: 0	DATE:	07/08/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Administrator- Andrea Perez		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff mishandle a resident's medications while in care.
Staff are not properly assisting a resident with diabetic medication.
Staff do not seek timely medical attention for a resident.
Staff are transporting a resident with broken medical equipment

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver the findings on the allegations listed above. LPA met with Administrator Andrea Perez and explained the purpose of today’s visit. The investigation consisted of staff interviews, resident interviews and record review.

For the allegation, Staff mishandle a resident's medications while in care. During staff interviews, all staff memebers stated they have not mishandled residents’ medication. During resident interviews, 5 out of the 6 resident stated all medications have been provided. LPA Rico reviewed residents’ medication MAR. Medications were dispensed and documented properly.

For the allegation, Staff are not properly assisting a resident with diabetic medication. During staff interviews, 3 out of the 7 staff indicated they assist with residents diabetic medication, but do not asisst with injections of insulin. During resident interviews, 5 out of the 6 residents stated they do not require insulin injections for diabetes.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025

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-20231114083849

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: 07/08/2025

NARRATIVE

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For the allegation, Staff do not seek timely medical attention for a resident. During resident interviews, all residents stated they receive medical attention in a timely manner. During staff interviews, all staff stated they assist their residents in a timely manner.

For the allegation, Staff are transporting a resident with broken medical equipment. During staff interviews, staff members stated the facility has a third-party agency that will repair broken medical equipment and resident will no be transported with a broken equipment. During resident interviews, 5 out of the 6 stated they receive assistance with medical repair and have not been transported with broken equipment.

Based on the evidence found during the investigation, the four (4) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation 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 Andrea Perez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025

LIC9099 (FAS) - (06/04)

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