336427235-10-29-2020-18-AS-EMAN-BUVSZF-20201030141904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336427235
Report Date: 10/27/2020
Date Signed: 10/29/2020 10:08:10 AM

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
08/06/2020 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200806131003

FACILITY NAME:	CORONA RESIDENTIAL CARE CENTER LLC		FACILITY NUMBER:	336427235
ADMINISTRATOR:	AHARON STRIKS		FACILITY TYPE:	740
ADDRESS:	1400 CIRCLE CITY DR		TELEPHONE:	(951) 735-0252
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	125	CENSUS: 89	DATE:	10/27/2020
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Mary Gonzales		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff mishandling residents medication
Staff not preventing resident from making inappropriate comments to another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility to deliver findings for the above allegations via telephone due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the call with Assisted Living Director, Mary Gonzales.

In regards to allegation #1, LPA attempted to interview Resident #1 (R1); however, R1 refused to be interviewed. LPA interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3) who all denied that staff are mishandling residents medications. According to S1, S2, and S3, there was a miscommunication between R1 and the pharmacy which caused R1 to believe R1's medications had already arrived. LPA interviewed the Assisted Living Director, who stated that R1 self administers medications on their own.

In regards to allegation #2, LPA interviewed S1, S2, and S3 who stated that there was one incident where another resident spoke to R2 inappropriately; however, it was immediately addressed by the Assisted

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

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-20200806131003

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: CORONA RESIDENTIAL CARE CENTER LLC	FACILITY NUMBER: 336427235
	VISIT DATE: 10/27/2020

NARRATIVE

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Living Director. According to the Assisted Living Director, Resident #2 (R2) was removed from the incident and staff took statements from both R1 and R2.

Based on evidence obtained during today’s visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and a copy was provided to the Assisted Living Director via email.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

LIC9099 (FAS) - (06/04)

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