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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336427235
Report Date: 06/30/2022
Date Signed: 06/30/2022 04:04:35 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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/27/2022 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220627101346
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: 96DATE:
06/30/2022
UNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Mary Gonzalez, AdministratorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility has bed bugs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to initiate an investigation for the above complaint allegation and deliver findings. LPA met with administrator, Mary Gonzalez.

The investigation consisted of the following: tour of the facility, specifically resident bedrooms and beds, interviews with facility staff and residents, review of facility files and copies of pertinent documents. The investigation revealed:

During the facility tour, LPA did not observe bed bugs to be present in the client’s bedrooms and on their beds. Five (5) out of five (5) interviews with staff revealed that staff has not personally observed bedbugs anywhere in the facility. Six out of six interviews conducted with clients revealed no clients observed bed bugs anywhere in the facility.
*********************Continued on LIC9099C*************************





Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
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 2
Control Number 56-AS-20220627101346
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
, CA 92507
FACILITY NAME: CORONA RESIDENTIAL CARE CENTER LLC
FACILITY NUMBER: 336427235
VISIT DATE: 06/30/2022
NARRATIVE
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Based on evidence obtained during the investigation, LPA has determined that the above allegation is UNSUBSTANTIATED; meaning that 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.

An exit interview was conducted with Gonzalez and a copy of this report was provided.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2