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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426511
Report Date: 01/29/2025
Date Signed: 01/29/2025 12:42:00 PM

Document Has Been Signed on 01/29/2025 12:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:VISTA CORONA SENIOR LIVINGFACILITY NUMBER:
336426511
ADMINISTRATOR/
DIRECTOR:		BLASIA LEE-LOLEFACILITY TYPE:
740
ADDRESS:737 MAGNOLIA AVETELEPHONE:
(951) 737-1600
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 180TOTAL ENROLLED CHILDREN: 0CENSUS: 97DATE:
01/29/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Executive Director Andrea PerezTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On 01/29/2025 at 09:45 AM, Licensing Program Analyst (LPA) Melody Brown met with Executive Director (ED) Andrea Perez to initiate Case Management Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation.

During the facility visit today, 01/29/2025, LPA Melody Brown requested a copy of the facility’s Personnel Report (LIC500) and interviewed ED Perez. LPA Brown reviewed document received and cross reference Guardian database and observed that Staff #1 (S1) has a background clearance, but was not associated to the facility as S1's criminal background clearance was not transferred to the facility prior to employment. ED Perez reported to LPA Brown that S1 started working at the facility today, 01/29/2025. ED Perez was informed that deficiency will be issued and Civil Penalty was assessed during the facility visit today, 01/29/2025 with the amount of $100.00 and will continue to be assessed of $100.00 per day per citation until corrected for not transferring criminal record clearance for S1 to the facility prior to employment.

An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to ED Andrea Perez.

Efren MalagonTELEPHONE: (951) 202-6356
Melody BrownTELEPHONE: 951-897-2187
DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/29/2025 12:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: VISTA CORONA SENIOR LIVING
FACILITY NUMBER: 336426511

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2025
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
CCR
87355(e)(2)
87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or
This requirement was not met as evidenced by:
Deficient Practice Statement
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POC Due Date: 02/05/2025
Plan of Correction
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Licensee stated to transfer S1 criminal background clearance to the facility and submit proof to LPA Brown by the plan of correction (POC) due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Efren MalagonTELEPHONE: (951) 202-6356
Melody BrownTELEPHONE: 951-897-2187

DATE: 01/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2025

LIC809 (FAS) - (06/04)
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