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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 11/13/2025
Date Signed: 11/13/2025 02:43:49 PM

Substantiated


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
08/18/2022 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220818162839
FACILITY NAME:AVISTA SENIOR LIVING MAGNOLIAFACILITY NUMBER:
336426511
ADMINISTRATOR:MONIQUE DEL JUNCOFACILITY TYPE:
740
ADDRESS:737 MAGNOLIA AVETELEPHONE:
(951) 737-1600
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:0CENSUS: DATE:
11/13/2025
UNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:TIME COMPLETED:
10:39 AM
ALLEGATION(S):
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Neglect/lack of care and supervision resulting in Resident #1 (R1) sustaining pressure injuries.
INVESTIGATION FINDINGS:
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On 11/13/2025 Licensing Program Analyst (LPA) Mary Rico mailed a certificated letter to deliver the findings on the allegation listed above. The investigation consisted of staff interviews, resident interviews, and document review.


On August 18, 2022, the Department received a complaint with allegation of personal rights violation resulting in R1 sustaining pressure injuries. The Department investigation consisted of review of facility and other records and interviews with pertinent individuals.

Investigation revealed that R1 was hospitalized on June 24, 2022, due to weakness. From time period of July 18, 2022, until July 22, 2022, R1 was hospitalized due to shortness of breath and fever. According to records, no pressure injuries were noted at both times. From time period of around July 22, 2022, until around August 11, 2022, facility staff did not indicate awareness of pressure injuries for R1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
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 3
Control Number 56-AS-20220818162839
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: 11/13/2025
NARRATIVE
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 However, it is noted that R1 was receiving hospice services effective August 11, 2022, and at that time, Hospice Nurse indicated R1 has wounds to bilateral heel, left foot, left arm and right hip. It is also noted that facility staff acknowledged at the time that R1 had been declining for the past several months.

R1 was admitted to the facility on May 27, 2022. R1 was assessed as non-ambulatory and used a wheelchair for mobility. Physician assessment indicates R1 was fall risk and was lifetime wheelchair assist due to generalized weakness. R1 was also incontinent and needed staff assistance with toileting needs, including changing of incontinent briefs. In addition, R1 needed care and assistance with activities of daily living such as bathing, dressing, and eating. R1 did not have a history of skin breakdown, according to an assessment dated April 19, 2022. Staff #1 (S1) indicated that they were not aware that R1 developed any pressure injuries while in care. In addition, records review did not reveal R1 change in condition following any hospitalizations nor an update to R1 written record of care.

On August 17, 2022, R1 was admitted to the hospital for dehydration and malnutrition. Upon admission, medical records show that R1 was diagnosed as having multiple pressure injuries including right lateral hip and right ankle. R1 was reported to have right lateral hip eschar/pressure injury and right ankle pressure ulcer. Moreover, multiple additional wounds are noted on R1.

Based on investigation, it is concluded that there is sufficient evidence to substantiate allegation of staff neglect of R1. As documented, R1 required staff assistance with activities of daily living, including incontinent care. However, it was found that facility staff did not provide the services needed by R1 to meet R1 needs. As a result, R1 sustained right lateral hip eschar/pressure injury, right ankle pressure ulcer and multiple additional wounds while in care. Furthermore, due to severity of R1’s pressure injuries, R1 was recommended at the hospital to consider surgery evaluation for right lateral hip wound debridement. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An immediate Civil Penalty in the amount of $500.00 is assessed. The licensee was informed that a civil penalty may be assessed based on Health and Safety Code 1569.49(f).

A copy of this report (LIC9099), LIC9099D, LIC421IM and Appeal Rights was mailed to facility’s designated mailing address

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20220818162839
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/13/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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No POC due to closure of facility and change of ownership.
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This requirement is not met as evidenced by: Based upon review of facility and other records, and interviews, licensee did not ensure that R1 was provided with care, supervision, and services required. As a result, R1 sustained pressure injuries while at facility. This violation posed an immediate health and safety risk to residents 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: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
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