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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530102
Report Date: 07/24/2025
Date Signed: 07/24/2025 02:36:14 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
04/18/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250418130652
FACILITY NAME:LOTUS VILLA AND MEMORY CAREFACILITY NUMBER:
365530102
ADMINISTRATOR:HEATHER O'NEELFACILITY TYPE:
740
ADDRESS:9448 CITRUS AVENUETELEPHONE:
(909) 355-6887
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:99CENSUS: 91DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Desiree Martinez- Med-TechTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal item.
Staff did not prevent a resident from sustaining falls while in care.
Staff did not prevent residents from engaging in an altercation.
Staff did not respond to resident's call light.
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 did not safeguard resident's personal item. Regarding the allegation LPA conducted an interview with Resident#1 pertaining to the allegation R#1 informed LPA that resident does not know if resident’s cellphone was misplaced, lost, or stolen. Resident #1 informed LPA that resident shares a room, however, resident#1 does not know if roommate or staff might have taken R#1 cellphone as R#1 has not witnessed any theft. Resident #1 informed LPA that resident has a designated area where resident stores their personal items. LPA conducted a review of R#1 records during the review of records LPA observed an inventory sheet that lists all valuable items pertaining to R#1. In addition, LPA observed that the facility has a Loss/and theft program to be in place.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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-20250418130652
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: 07/24/2025
NARRATIVE
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Second allegation: Staff did not prevent a resident from sustaining falls while in care. Regarding the allegation LPA conducted a review of records pertaining to Resident #1 during the review of records LPA discovered that R#1 was considered a fall risk. LPA observed that R#1 had a fall risk sign in resident room to keep staff informed. Based on documentation LPA discovered that 15-30minute round checks are implemented for residents who are listed as fall risk. addition, LPA discovered that R#1 utilizes a walker to ambulate. Furthermore, during the review of record LPA discovered that resident sustained a few falls on different occasions. LPA observed that last fall occurred on 6/11/2025 while resident was out with family. LPA conducted interviews with staff and staff informed LPA that resident does not call for help when needed, in addition, staff informed LPA that Resident #1 does not comply with directions when it comes to asking for assistance.

Third allegation: Staff did not prevent residents from engaging in an altercation. Regarding the allegation LPA conducted interview with Resident #1 regarding the allegation listed R#1 informed LPA that Resident #1 was upset and smacked her hand which caused residents phone to shatter. In addition, Resident #1 informed LPA that resident does not get along with R#2 and both residents argue constantly. LPA conducted an interview with Resident #2 who informed LPA that R#1 was bothering R#2 and had enough and smacked R#1 hand. R#1 and R#2 informed LPA that management has offered residents to be relocated to another room and both R#1 and R#2 declined and stated that they liked their room and don’t want to be relocated. LPA conducted interviews with staff#1 and Staff #2 who informed LPA that conversations were held with both residents who were made aware that aggressive behavior will not be tolerated, and a 30-day notice will be issued if such behaviors continued.

Fourth allegation: Staff did not respond to resident's call light. Regarding the allegation listed above LPA conducted an interview with R#1 who informed LPA that staff take over 30 minutes to respond to residents call light. LPA conducted interviews with R#3 R#4, and R#5 who informed LPA that they have no issues regarding staff not responding to their calls R#4 informed LPA that the longest resident has waited was 40-minutes. R#4 informed LPA that resident feels safe and has no issues to report at the time. LPA conducted Interviews with Staff #3 and Staff #4 who informed LPA that staff always respond to resident’s calls. Staff#2 also informed LPA that during busy times or during certain incidents staff will take a little longer but will respond within 35-minutes.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250418130652
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: 07/24/2025
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: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3