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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 12/19/2025
Date Signed: 12/19/2025 03:28:34 PM

Unsubstantiated


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
06/04/2024 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20240604130432
FACILITY NAME:AVISTA SENIOR LIVING MAGNOLIAFACILITY NUMBER:
336426511
ADMINISTRATOR:BLASIA LEE-LOLEFACILITY TYPE:
740
ADDRESS:737 MAGNOLIA AVETELEPHONE:
(951) 737-1600
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:0CENSUS: 93DATE:
12/19/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive DIrector, Andrea PerezTIME COMPLETED:
03:35 PM
ALLEGATION(S):
1
2
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7
8
9
Personal rights
INVESTIGATION FINDINGS:
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13
On 12/19/2025 at 9:30AM, Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility to deliver findings for the above allegation. LPA met with Executive Director, Andrea Perez, introduced self and stated the purpose of the visit.

It is alleged that staff physically abused Resident 1 (R1). LPA conducted interviews with R1 and staff. R1 stated that the bruising on their arms was a result of the intravenous (IV) procedures when R1 was hospitalized. R1 denied the allegation and stated that staff treat R1 well and provides the care that they need. LPA interviewed staff and staff denied the allegation. Based on interviews conducted with resident and staff, and a review of facility records, the allegation is UNSUBSTANTIATED.

An UNSUBSTANTIATED complaint is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
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 4
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
06/04/2024 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20240604130432

FACILITY NAME:AVISTA SENIOR LIVING MAGNOLIAFACILITY NUMBER:
336426511
ADMINISTRATOR:BLASIA LEE-LOLEFACILITY TYPE:
740
ADDRESS:737 MAGNOLIA AVETELEPHONE:
(951) 737-1600
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:0CENSUS: 93DATE:
12/19/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive DIrector, Andrea PerezTIME COMPLETED:
03:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9

Staff do not ensure that resident's toileting needs are being met while in care
Staff do not ensure that resident's showering needs are being met while in care
Staff emotionally abuse resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/19/2025 at 9:30AM, Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility to deliver findings for the above allegation. LPA met with Executive Director, Andrea Perez, introduced self and stated the purpose of the visit. The investigation consisted of interviews and record review.

In regards to the allegation of staff do not ensure that resident's toileting needs are being met while in care:
LPA interviewed eight (8) staff and (8) residents. All six (6) out of eight (8) residents interviewed stated that their toileting needs are met. Staff denied the allegation and stated that residents are assisted with their needs based upon their care plan and more if needed. Based on interviews and record review, this allegation is UNSUBSTANTIATED.

In regards to the allegation of staff do not ensure that resident's showering needs are being met while in care: Staff stated that Resident 1 (R1) intially needed minmal assistance and now needs a higher level of
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
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 4
Control Number 56-AS-20240604130432
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: AVISTA SENIOR LIVING MAGNOLIA
FACILITY NUMBER: 336426511
VISIT DATE: 12/19/2025
NARRATIVE
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care. R1 stated that their needs are being met. Staff also document when showers are completed or refused. Based upon interviews and record review this allegation is UNSUBSTANTIATED.

In regards to the allegation of staff emotionally abuse resident in care:
R1 stated that staff treat R1 well. Residents stated that staff treat the residents well. Staff denied the allegation and stated that they treat all of the residents with respect. Based upon interview, this allegation is UNSUBSTANTIATED.

UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted where this report LIC9099 and LIC9099C were discussed and copies were provided to Executive Director, Andrea Perez.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20240604130432
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: AVISTA SENIOR LIVING MAGNOLIA
FACILITY NUMBER: 336426511
VISIT DATE: 12/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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21
22
23
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32
An exit interview was conducted where this report LIC9099 and LIC9099C were discussed and copies provided to Executive Director, Andrea Perez.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4