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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530102
Report Date: 08/11/2025
Date Signed: 08/11/2025 12:13:50 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
08/30/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240830134517
FACILITY NAME:LOTUS VILLA AND MEMORY CAREFACILITY NUMBER:
365530102
ADMINISTRATOR:PARRA, REBECCAFACILITY TYPE:
740
ADDRESS:9448 CITRUS AVENUETELEPHONE:
(909) 355-6887
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:99CENSUS: 94DATE:
08/11/2025
UNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Heather O'NeelTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff allowed resident to become dehydrated while in care.
Staff did not prevent outbreak of covid.
Staff did not report a change in resident's condition to resident's responsible party.
Staff did not provide adequate care to resident while 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, observations, and review of records.

First allegation: Staff allowed resident to become dehydrated while in care. Regarding the allegation LPA conducted interviews with Resident #2-5 regarding the allegation listed above all residents informed LPA that facility has water available to all residents. In addition, resident #2-5, informed LPA that facility has water dispensers available throughout the facility, and that water is also provided upon residents’ request. LPA conducted interviews with Staff #1-5, 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 #1-5 also informed LPA that pitchers of water are provided, to assist residents when taking medication.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
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-20240830134517
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: 08/11/2025
NARRATIVE
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Second allegation: Staff did not prevent outbreak of covid. Regarding the allegation LPA conducted interviews with Resident #2-5 regarding the allegation “Staff did not prevent outbreak of covid.” And Resident #2-5 informed LPA that staff conduct COVID testing on residents that are exhibiting COVID symptom’s residents informed LPA that residents are quarantined during positive readings. Resident #2-5 further explained that staff are wearing masks and housekeepers disinfect all COVID areas. Resident #1 informed LPA that although facility cleans and disinfects that it is difficult to prevent COVID because residents attend their PACE Program “InnoVage” and go out and visit their families, and later come back sick or test positive due to outside exposure. LPA conducted interviews with Staff #1-5 regarding the allegation, and all staff informed LPA that during a COVID-19 positive reading that all staff are informed and wear the Proper Protective Equipment (PPE), to help minimize the spread. In addition, Staff #1-5 informed LPA that all common areas are disinfected by housekeepers and residents are quarantined. In addition, staff also informed LPA that during exposures or outbreaks facility will conduct COVID rapid testing every two days to help detect new COVID cases. In addition, staff informed that all cases would be reported to CCL Regional Office and Department of Public Health.

Third allegation: Staff did not report a change in resident's condition to resident's responsible party. Regarding the allegation stated above LPA conducted an interview with Staff #6 regarding Resident #1 LPA requested documentation pertaining to R#1 upon the review of documentation LPA observed Doctor’s communication notes pertaining to Resident #1 and resident change of condition. In addition, during further review of Resident #1 records LPA observed that special incident reports (SIR), were documented and reported to Resident #1 Responsible Party.

Fourth allegation: Staff did not provide adequate care to resident while in care. Regarding the allegation LPA conducted interviews with Resident #2-5 regarding the allegation listed above and R#2-5 informed LPA that facility staff provide the necessary care that meets their needs. In addition, R#2-5 informed LPA that they have no concerns to report regarding to their care. LPA conducted interviews with Staff #1-3 regarding the allegation and staff #1-3 informed LPA that staff ensures that residents care needs are always provided. In addition, Staff #1-5 informed LPA that they have not witness staff deny or retain care to any resident in care. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20240830134517
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: 08/11/2025
NARRATIVE
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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: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3