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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 02:20:42 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
09/03/2021 and conducted by Evaluator Jennifer Semin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210903094757
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:
12:30 PM
MET WITH:Mary GonzalezTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff refused to help resident seek medical help
Resident's hygiene needs are not being met
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 deliver the findings for the above allegations. LPA met with Assistant Administrator Mary Gonzalez.
The investigation consisted of interviews with staff and relevant parties. Regarding the first allegation, Staff refused to help resident seek medical help. Staff interviews revealed staff made all necessary post-surgery appointments for Resident 1 (R1) and followed all discharge instructions from R1 physician, including baths. Staff stated the first appointments available were later than the discharge papers requested by were scheduled by first available. R1 stated staff did not make the follow up appointments in a timely manner. The second allegation, Resident's hygiene needs are not being met. Staff stated they meet all their resident’s hygiene needs. Staff began giving R1 daily sponge baths once R1’s doctor’s order was received. R1 stated staff did not begin following doctor’s hygiene order right away. Documents revealed R1 was given daily sponge baths per doctor’s order.Based upon interviews and information gathered, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation 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.
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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