365530102-8-26-2025-56-AS-EMAN-DKYQJL-20250828121254

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 365530102
Report Date: 08/26/2025
Date Signed: 08/26/2025 02:06:06 PM

Unsubstantiated

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
12/15/2023 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231215091035

FACILITY NAME:	LOTUS VILLA AND MEMORY CARE		FACILITY NUMBER:	365530102
ADMINISTRATOR:	PARRA, REBECCA		FACILITY TYPE:	740
ADDRESS:	9448 CITRUS AVENUE		TELEPHONE:	(909) 355-6887
CITY:	FONTANA	STATE: CA	ZIP CODE:	92335
CAPACITY:	99	CENSUS: 94	DATE:	08/26/2025
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Heather O'Neel		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not follow up on resident's change of condition
Staff left resident in filthy clothes
Staff did not ensure resident in care was hydrated
Staff did not ensure resident in care was properly fed
Staff did not provide proper medication assistance to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Heather O’Neel and explained the purpose of the visit. The investigation consisted of interviews, observation, and review of records.

First allegation: Staff did not follow up on resident's change of condition. Regarding the allegation stated above LPA conducted interviews with S#1, S#2, and S#3, who informed LPA that on 11/19/2023, facility informed InnoVage clinic that Resident #1 was being transported to local hospital because R#1 was weak and was not eating. LPA collected documentation pertaining to R#1 and LPA discovered that on 11/19/2023, R#1 was seen at a local hospital and diagnosed with UTI R#1, was discharged on the same day. LPA observed that medication was set to be delivered to the facility per InnoVage orders. LPA observed that R#1 completed antibiotics as indicated in addition, based on R#1 follow-up information documentation indicated that R#1 is to return within 1-2 days if any problems or concerns. Based on documentation no problems or concerns were listed after R#1 discharge.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025

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 56-AS-20231215091035

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: LOTUS VILLA AND MEMORY CARE	FACILITY NUMBER: 365530102
	VISIT DATE: 08/26/2025

NARRATIVE

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Second allegation: Staff left resident in filthy clothes. Regarding the allegation listed above LPA conducted interviews with Resident #2, Resident #3, R#4, and Resident #5, who informed LPA that facility provides laundry services as part of their agreement. In addition, R#2-5 informed LPA of not having any issues or concerns regarding laundry services. R#2-5 informed LPA that caregivers change and dress residents twice a day (morning & night), and as needed in case resident might need a diaper change or during an accident. LPA conducted a file review and observed that the facility provides laundry services to residents as part of their basic services listed on their admission agreement. LPA conducted interviews with Staff #1, S#2, and Staff #3, who informed LPA that facility provides laundry services twice a week for all residents or as needed.
Third allegation: Staff did not ensure resident in care was hydrated. Regarding the allegation LPA conducted interviews with Resident #2, Resident #3, Resident #4, and Resident #5 regarding the allegation stated above and all residents informed LPA that facility provides and has water available to all residents in care. In addition, resident #2-5, informed LPA that the facility has water dispensers available throughout the facility. In addition, water is also provided to resident[s] upon residents’ request. LPA conducted interviews with Staff #1-3, regarding the allegation stated above, and staff #1-5 informed LPA that there is a total of three (3), water stations available to residents and that water is also available upon residents’ request. Furthermore, Staff #1, S#2, and Staff #3, also informed LPA that pitchers of water are provided, to assist residents when taking medication.

Fourth allegation: Staff did not ensure resident in care was properly fed. Regarding the allegation LPA conducted interviews with Resident #2, Resident #3, Resident #4, and Resident #5 who informed LPA that facility provides residents with breakfast, lunch, dinner, and in between snacks, R#2-5 also informed LPA that the facility provide options from their optional menu incase the resident does not want to eat what is being served. In addition, R#2-5 informed LPA that facility has a dining area where residents eat however, caregivers will usually take residents food into resident’s room incase resident is not in the dining area. LPA conducted interviews with S#1, S#2, and S#3, LPA went over the allegation with staff and S#1-3 informed LPA that all residents are provided three meals a day and food is typically provided in the dining area or delivered to the resident depending on residents needs.

Fifth allegation: Staff did not provide proper medication assistance to resident in care: Regarding the allegation stated above LPA conducted interviews with Staff #1, S#2, and Staff #3, who informed LPA that on 11/19/2023 Resident #1 was transported to local hospital for further evaluation

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20231215091035

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: LOTUS VILLA AND MEMORY CARE	FACILITY NUMBER: 365530102
	VISIT DATE: 08/26/2025

NARRATIVE

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regarding R#1 being weak and not eating. LPA requested for documentation pertaining to Resident #1 during review of record LPA discovered that after R#1 discharge R#1 was prescribed Cephalexin (Keflex 500 Mg) to take twice a day for five (5), days for UTI. Based on R#1 medication list R#1 completed treatment. In addition, during further record review LPA observed that resident was diagnosed with urinary tract infection, and weakness, no indication of dehydration was listed as a diagnosis for Resident #1. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.

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 where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Heather O’Neel at the end of the visit.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025

LIC9099 (FAS) - (06/04)

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