336427235-8-6-2024-18-AS-JDHS-D87UHV-20240816153634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336427235
Report Date: 08/06/2024
Date Signed: 08/06/2024 09:50:57 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2021 and conducted by Evaluator Yolanda Delgado

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210223101326

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: 90	DATE:	08/06/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mary Gonzalez		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained a fall due to obstructions in the hallway
Facility staff not appropriately assisting resident with meals
Staff using inappropriate language with resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Yolanda Delgado made an unannounced visit to the facility to deliver findings for a complaint investigation into the allegations listed above. During the investigation, LPA interviewed eight (8) staff members and ten (10) residents. LPA reviewed pertinent documents pertaining to the allegations.

On February 23, 2021, Community Care Licensing received a complaint alleging resident sustained a fall due to obstructions in the hallway, facility staff not appropriately assisting resident with meals, and staff is using inappropriate language with resident.
Regarding the allegation that Resident #1 (RI) sustained a fall due to an obstruction in the hallway. (Continued on Page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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 3

Control Number 18-AS-20210223101326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CORONA RESIDENTIAL CARE CENTER LLC	FACILITY NUMBER: 336427235
	VISIT DATE: 08/06/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from Page 1)

It was reported that R1 fell in July 2020 because staff left walkers and wheelchairs in the hallway. It was reported that R1 roams the facility at night. During that time, the lights in the facility are low and R1 tripped over a walker. It was stated that R1 reported the fall to staff and S2 asked R1 if they would like to be sent out to the hospital. It was reported that R1 refused, but was later evaluated and there were no injuries. Information obtained from interviews with staff and residents stated residents that use a walker or wheelchair, store their devices in their rooms.
Regarding the allegation that the facility staff did not appropriately assist resident with meals, it was reported during COVID, the facility served meals to the residents’ rooms. It was reported that R1 was not provided meals unless they asked. Information obtained from interviews with residents denied that facility staff did not feed them or assist with meals. Interviews with staff also denied the allegation. It was stated that residents were always provided meals. It was further advised that with the process of passing out meal trays, the facility incorporated the use of walk talkies to be able to communicate with kitchen staff to bring additional or different food trays. Facility Administration completed in-service training dated on February 23, 2021 regarding food service. Due to the allegation, the facility did complete their own investigation, in which three staff were interviewed. It was stated that during one feeding, one of the staff had to move with the cart out of the way to let another resident pass. When R1 opened their door, R1 seen the staff moving, R1 got upset. R1 was still provided their meal. Administration met with R1 to discuss R1’s concerns and explain the incident, however R1 became upset with Administrator during the discussion. Administrator apologize for the confusion.
Regarding the allegation that staff are using inappropriate language with residents, it was reported that Staff (S1), Administrator stated to R1, “We are going to make sure you get your damn juice.” LPA conducted interviews with staff and it was revealed that S1 was not on shift on the day R1 stated the allegation occurred. LPA also conducted interviews with residents and the interviews did not reveal that any residents had been inappropriately spoken to by S1 or any other staff.

(Continued on Page 3)

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20210223101326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CORONA RESIDENTIAL CARE CENTER LLC	FACILITY NUMBER: 336427235
	VISIT DATE: 08/06/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from Page 2)

Based on LPAs observations and interviews, the preponderance of evidence standard has not been met. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided along with LIC811 – Confidential Names List.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3