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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336427235
Report Date: 12/07/2021
Date Signed: 12/07/2021 01:48:13 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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2021 and conducted by Evaluator Jennifer Semin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211201141446
FACILITY NAME:CORONA RESIDENTIAL CARE CENTER LLCFACILITY NUMBER:
336427235
ADMINISTRATOR:AHARON STRIKSFACILITY TYPE:
740
ADDRESS:1400 CIRCLE CITY DRTELEPHONE:
(951) 735-0252
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:125CENSUS: 111DATE:
12/07/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Mary GonzalezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is being overmedicated while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to initiate an investigation and deliver the findings for the above allegation. LPA met with Assistant Administrator Mary Gonzalez.
The investigation consisted of interviews with staff and relevant parties. Regarding the allegation, Resident is being overmedicated while in care. Staff interviews revealed all residents, including Resident 1 (R1), are given their medication according to the physician’s order. Staff state they document and notify resident’s responsible party when any changes in condition occur. Responsible Party (RP) stated facility notifies RP of any change in condition for R1. Relevant parties state R1 is prescribed too much medication by their physician. Facility documents revealed the facility is giving medication according to the physician’s order.
Based upon interviews and information gathered, and although the allegation 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 was discussed and provided to Ms. Gonzalez.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer SeminTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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