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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 05/15/2025
Date Signed: 05/15/2025 03:53:05 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
05/09/2025 and conducted by Evaluator Raquel Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250509082906
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: 102DATE:
05/15/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Executive Director Andrea PerezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff provided dirty utensils to residents in care
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 provided dirty utensils to residents in care

LPA Hernandez conducted (6) resident interviews. 4 out of the 6 resident stated they have received dirty utensils and cups at the facility periodically. LPA Hernandez conducted (5) staff interviews. 2 out of the 5 staff stated they witnessed dirty utensils or cups being provided to residents. However, staff indicated when this occurs residents are provided a new dish or utensil. Additionally, LPA Hernandez observed several cups and dishes to be dirty with left over food and coffee stains.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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-20250509082906
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: 05/15/2025
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: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 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
05/09/2025 and conducted by Evaluator Raquel Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250509082906

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: DATE:
05/15/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Executive Director Andrea PerezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is malodorous
Facility is unsanitary
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, Facility is malodorous.

LPA Hernandez conducted (6) resident interviews. 6 out of the 6 residents stated there are no foul odors in the facility. LPA Hernandez conducted (5) staff interviews. 5 out of the 5 staff stated facility has never had a foul odor. Additionally, LPA Hernandez observed no foul odors at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20250509082906
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: 05/15/2025
NARRATIVE
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For the allegation, Facility is unsanitary.

LPA Hernandez conducted (6) resident interviews. 6 out of the 6 residents stated the facility is always kept clean and is not unsanitary. LPA Hernandez conducted (5) staff interviews. 5 out of the 5 staff stated the facility is always kept clean and have not witnessed facility being unsanitary. Additionally, LPA Hernandez observed facility to be clean and sanitary.

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: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20250509082906
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: 05/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
05/16/2025
Section Cited
CCR
87555(b)(30)
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87555 General Food Service Requirements (b)The following food service requirements shall apply: (30) All utensils used for eating and drinking and in preparation of food and drink, shall be cleaned and sanitized after each usage.
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Licensee stated to submit staff training on sanitizing food utensils and cups to LPA Hernandez by Plan of Correction (POC) due date.
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Based on observation and interview, the licensee did not comply with the section cited above by not ensuring all cups and utensils were kept clean and sanitary which poses an immediate health safety or 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: 05/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5