336426511-10-8-2024-56-AS-EMAN-DA4VHT-20241016162738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 10/08/2024
Date Signed: 10/08/2024 03:53:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/19/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240619161707

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: 101	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Sales Director Chad Ormsby and Business Office Manager Rona Sanchez		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Illegal eviction.

INVESTIGATION FINDINGS:

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On 10/08/2024 at 03:30 PM, Licensing Program Analyst (LPA), Melody Brown arrived at the facility unannounced to deliver the investigative findings for the above allegation. LPA Brown identified herself and discussed the purpose of the visit with Sales Director Chad Ormsby and Business Office Manager Rona Sanchez.

The investigation was conducted by LPA Melody Brown. The investigation consisted of file review and
interviews with relevant parties. The allegation indicated Illegal eviction. Interviews with hospital Social Worker indicated that no illegal eviction occured for Resident #1 (R1) as R1 told hospital social worker on 06/17/2024 that R1 does not want to return to the facility and with that information, they looked for a new placement for R1. Hospital Social Worker added that R1 was discharged to a board and care on 06/18/2024 and reiterated that the facility did not illegaly evicted R1 as R1 did not want to return to the facility.

**Continuation on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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-20240619161707

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 10/08/2024

NARRATIVE

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Evidence shows that no staff at the facility illegally evicted R1. Evidence also showed that when R1 was interviewed by hospital Social Worker, R1 indicated that R1 does not want to return to the facility.

There is insufficient evidence to prove that the facility illegally evicted R1. The evidence also demonstrates that R1 told hospital Social Worker that R1 does not want to return to the facility that's why the hospital social worker searched for a new placement for R1 and R1 was discharged to the board and care on 06/18/2024. Therefore, based on the evidence obtained during the investigation, the allegation of Illegal Eviction is unsubstantiated at this time. Although the allegation of Illegal Eviction may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report (LIC9099) was discussed and provided to Sales Director Chad Ormsby and Business Office Manager Rona Sanchez.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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