336427235-10-16-2023-56-AS-EMAN-CWSUH7-20231020153528

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336427235
Report Date: 10/16/2023
Date Signed: 10/16/2023 10:41:46 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
10/12/2023 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231012154056

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: 87	DATE:	10/16/2023
		UNANNOUNCED	TIME BEGAN:	08:47 AM
MET WITH:	Maria "Mary" Gonzalez - Administrator Assistant		TIME COMPLETED:	10:53 AM

ALLEGATION(S):

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Resident’s restroom does not accommodate wheelchair access.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner arrived at the facility unannounced to investigate and deliver findings for the above complaint allegation. LPA met with Administrator Assistant Maria "Mary" Gonzalez and explained the reason for the visit.

During today’s visit, LPA toured the facility, interviewed residents, interviewed staff, and reviewed facility documents.

For allegation, Resident’s restroom does not accommodate wheelchair access:

LPA tour of Resident R1’s bedroom revealed that R1 does not have access to their bathroom due to the size of the bathroom door. R1 is not able to wash their hands, brush their teeth, wash their face, and or use the bathroom in their bedroom. Document reveal of R1’s physicians report, LIC 602A, dated 9/21/2023 details that R1 is able to care for their own toileting and grooming needs.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

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 56-AS-20231012154056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CORONA RESIDENTIAL CARE CENTER LLC	FACILITY NUMBER: 336427235
	VISIT DATE: 10/16/2023

NARRATIVE

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When R1 needs to use the bathroom for basic needs, R1 is required to leave their bedroom and use the facilities shower room or bathroom in the main area of the facility. Interviews and document review revealed that R1 requested to be moved to a different bedroom on 9/23/2023 and on 9/28/2023 due to roommate accommodations. The facility moved the R1 to two (2) different bedrooms per R1’s request. The facility failed to take in consideration of R1’s basic bathroom needs when moving R1 to a different bedroom. The facility should have selected a bedroom where R1 had full access to a bathroom in order for R1 to have access to basic bathroom needs. The facility gave R1 a portable commode that has been placed outside of their bathroom door. The portable commode does not accommodate or take place of R1’s full basic bathroom needs.

Based on the evidence gathered during the investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because of the preponderance of evidence the standard has been met.

During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and the LIC9099D form were discussed and provided to Administrator Assistant Maria "Mary" Gonzalez, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20231012154056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CORONA RESIDENTIAL CARE CENTER LLC	FACILITY NUMBER: 336427235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/17/2023 Section Cited CCR 87307(d)(1)	1 2 3 4 5 6 7	87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities:(1) Sufficient room shall be available to accommodate persons served in comfort and safety.	1 2 3 4 5 6 7	The licensee has agreed to read regulation 87307 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to move R1 to a bedroom that accommodates R1’s basic bathroom needs by the POC due date. POC is due by 10/17/2023.
	8 9 10 11 12 13 14	Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not providing a bedroom with accommodations for their basic bathroom needs which poses a potential health, safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

LIC9099 (FAS) - (06/04)

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