365530102-7-22-2025-56-AS-EMAN-DJUTWZ-20250723150622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 365530102
Report Date: 07/22/2025
Date Signed: 07/22/2025 03:41:02 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
02/10/2025 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250210141739

FACILITY NAME:	LOTUS VILLA AND MEMORY CARE		FACILITY NUMBER:	365530102
ADMINISTRATOR:	HEATHER O'NEEL		FACILITY TYPE:	740
ADDRESS:	9448 CITRUS AVENUE		TELEPHONE:	(909) 355-6887
CITY:	FONTANA	STATE: CA	ZIP CODE:	92335
CAPACITY:	99	CENSUS: 92	DATE:	07/22/2025
		UNANNOUNCED	TIME BEGAN:	01:32 PM
MET WITH:	Reyna Figueroa		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff neglect resulted in resident falling.
Staff did not ensure resident’s room was adequately cleaned.
Staff did not ensure resident’s room was free from odors.
Staff did not safeguard resident's personal belongings.
Staff did not assist resident with personal hygiene 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 Business Office Manager Reyna Figueroa and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Staff neglect resulted in resident falling. Regarding the allegation listed above LPA conducted a review of records pertaining to Resident #1 during the review of records LPA discovered that R#1 sustained an unwitnessed fall on 9/25/2024, based on report R#1 was later transported to local hospital for treatment. During further investigation LPA observed that R#1 has not sustained no falls since initial fall that occurred on 9/24/2024. LPA conducted an interview with Resident#1 pertaining the allegation stated above R#1 informed LPA that during the fall resident was attempting to lean to the side and went a little to far and that is when resident sustained the fall. Resident #1 informed LPA that staff neglect was not the reason R#1 sustained the fall but rather an accidental fall.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025

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-20250210141739

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: 07/22/2025

NARRATIVE

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Second allegation: Staff did not ensure resident’s room was adequately cleaned. Regarding the allegation “Staff did not ensure resident’s room was adequately cleaned” Prior to the start of LPA’s interview LPA observed two housekeepers cleaning R#1 room. LPA conducted interviews with both housekeepers who informed LPA that R#1 room gets cleaned daily. During the time of the visit LPA observed that R#1 room was clean and organized. LPA conducted an interview with Resident #1 who informed LPA that housekeeping services are done daily and has no concerns pertaining to housekeeping services at the facility.

Third allegation: Staff did not ensure resident’s room was free from odors. Regarding the allegation “Staff did not ensure resident’s room was free from odors” Prior to the start of LPA’s interview LPA observed two housekeepers cleaning R#1 room. LPA conducted interviews with both housekeepers who informed LPA that R#1 room gets cleaned daily and as needed. LPA conducted an interview with Resident #1 who informed LPA that housekeeping services are done daily and has no concerns pertaining to housekeeping services. However, R#1 informed LPA that resident’s roommate is not clean and at times refuses to be changed and at times the room can hold a strong urine odor. During the time of the visit LPA observed that R#1 room was clean, organized, and free of odors.

Fourth allegation: Staff did not safeguard resident's personal belongings. Regarding the allegation “Staff did not safeguard resident’s personal belongings” LPA conducted an interview with Resident #1 pertaining to the allegation stated above Resident #1 informed LPA resident is not aware of the items that might have been misplaced R#1 informed LPA that resident has not witnessed anyone take residents personal belongings. Resident #1 informed LPA that resident had misplaced TV remote however, resident informed LPA that the remote was replaced and has not been misplaced since. Resident informed LPA that resident has no issues or concerns regarding resident’s belongings.

Fifth allegation: Staff did not assist resident with personal hygiene care. Regarding the allegation stated LPA conducted an interview with Resident #1 pertaining to the allegation stated above during the investigation R#1 informed LPA that resident has no concerns regarding facility not meeting residents’ personal hygiene. Prior to LPA conducting her interview LPA was waiting outside residents’ room because resident was being dressed and change by care staff. During the interview with R#1 resident informed LPA that care staff change residents briefs daily and as needed. Resident informed LPA that during the day resident can utilize the restroom but require supervision due to resident’s vision impairment. During review of record LPA observed that Resident #1 is under SCAN Health Plan and receives in-house care by SCAN. LPA obtained a copy of Resident#1 shower schedule and observed that R#1 receives showers twice a week (Wed and Sat).

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20250210141739

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: 07/22/2025

NARRATIVE

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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 Business Office Manager Reyna Figueroa at the end of the visit.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025

LIC9099 (FAS) - (06/04)

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