336426511-11-8-2021-18-AS-EMAN-C9SS4Y-20211217123332

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 11/08/2021
Date Signed: 11/08/2021 01:12:12 PM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2021 and conducted by Evaluator Jennifer Semin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211103095201

FACILITY NAME:	AVISTA SENIOR LIVING MAGNOLIA		FACILITY NUMBER:	336426511
ADMINISTRATOR:	MONIQUE DEL JUNCO		FACILITY TYPE:	740
ADDRESS:	737 MAGNOLIA AVE		TELEPHONE:	(951) 737-1600
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	180	CENSUS: 113	DATE:	11/08/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Diana Gonzalez		TIME COMPLETED:	01:28 PM

ALLEGATION(S):

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Facility staff are restricting visitation
Facility staff stole residents belongings
Facility staf are not asking permission to enter apartments
Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analys (LPA) Jennfier Semin conducted an unannounces visit to initiate a complaint investigation and deliver the findings for the above alegations. LPA met with Business Office Manager, Diana Gonzalez and spoke with Administrator Blasia Lee via telephone as she was in a meeting.

The investigation consisted of observations and interviews. The first allegation, Facility staff are restricting visitation. All staff state visitors are allowed and permitted to visit in resident apartments if they are fully vaccinated or have a negative COVID test within 72 hours. Resident 2-7 (R2-R7) stated they are permitted to have visitors in their apartments. Resident 1 (R1) stated her vaccinated family member was denied entry to her apartment. R1 could not recall the date or time.
The second allegation, Facility staff stole residents belongings. All staff stated they have never nor have they ever seen any staff steal the residents belongings. Housekeeping staff stated they do not take residents belongings. They stated they do throw away trash from residents rooms, not clothing or belongings.R2-7 stated they have never noticed any belongings missing. R1 stated several grocery bags containing papers were taken from her room. Housekeeping staff do not recall grocery bags full of papers in R1's room.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer Semin	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

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 18-AS-20211103095201

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
RIVERSIDE, CA 92507

FACILITY NAME: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 11/08/2021

NARRATIVE

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The third allegation, Facility staff are not asking permission to enter apartments. All staff stated they always knock before entering resident apartments. They all stated for non-emergency calls they will wait for several minutes and knock repeatedly before entering to assist residents. R2-R7 stated staff always knock and generally wait for them to respond before entering their apartments. Care-giving staff stated they do not go into R1's apartment unless specifically asked by R1 as R1 does not usually require staff assistance. R1 stated staff just come in her apartment without knocking.
The fourth allegation stated, Facility is in disrepair. All staff stated the facility is not in disrepair, anything that needs to be fixed or repaired is completed in a timely manner. R2-R7 stated they have not had any issues with anything being in disrepair or broken. R1 stated the toilet in her bathroom was running after being flushed. R1 stated maintenance has come up to check the toilet but they didn't do anything. LPA observed that the ruining water was normal tank refilling sounds. Maintenance Staff (MS) stated they have a work order to tighten the toilet seat in R1's bathroom. MS stated to there is nothing wrong with R1's toilet nor is there anything broken in R1's apartment.
Based on interviews and observations and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.
An exit interview was conducted where this report was discussed and provided to Ms. Gonzalez.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer Semin	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

LIC9099 (FAS) - (06/04)

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