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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336427235
Report Date: 05/20/2025
Date Signed: 05/29/2025 03:46:39 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
02/13/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240213165029
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: 89DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Assistant Administrator Mary GonzalezTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not reappraise resident as necessary.
Facility did not have enough staff to meet the needs of resident in care.

INVESTIGATION FINDINGS:
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On 05/29/2025 at 03:00 PM, Licensing Program Analyst (LPA), Melody Brown, met with Assistant Administrator Mary Gonzalez at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office to amend the complaint investigation findings for the above allegations delivered on 05/20/2025.LPA Brown explained the purpose of the requested Office Visit to Assistant Administrator Gonzalez. After introducing and identifying self, LPA Brown met Assistant Administrator Mary Gonzalez to discuss the findings.

The investigation was conducted by Department staff. The investigation consisted of file review and interviews with relevant parties. The first allegation indicates staff did not reappraise resident as necessary. The Department staff investigation revealed that Resident #1 (R1) had an ankle fracture suffered in 07/2023 after R1 fell out of R1's wheelchair. ***Continuation in LIC9099C***
***This is an amended report for the Complaint Investigation Report (LIC9099) issued on 05/20/2025***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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 5
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
02/13/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240213165029

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: 89DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Assistant Administrator Mary GonzalezTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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9
Resident died due to staff neglect.
INVESTIGATION FINDINGS:
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On 05/20/2025 at 08:30 AM, Licensing Program Analyst (LPA), Melody Brown, visited the facility to deliver the investigative findings for the above allegation. LPA Brown identified herself and discussed the purpose of the visit with Assistant Administrator Mary Gonzalez.

The investigation of the allegation was conducted by Department staff. The investigation consisted of file review and interviews with relevant parties. The allegation indicates that resident died due to staff neglect. Department staff investigation revealed that Resident #1 (R1) fell when R1 stood up from R1’s wheelchair before Staff #3 (S3) was ready and in position to assist R1 with a diaper change. Moreover, Department staff investigation indicated that even though S3 was mere feet away from R1, S3 was unable to prevent R1 from falling and sustaining head trauma and because of these circumstances, it cannot be conclusively established that R1’s subsequent death was due to staff neglect. In addition, Department staff records review showed that R1 was treated surgically for the head trauma but suffered from other medical conditions and comorbidities as well. ***Continuation in LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20240213165029
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: 05/20/2025
NARRATIVE
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Therefore, based on the evidence obtained during the Department's investigation, the allegation of resident died due to staff neglect is UNSUBSTANTIATED at this time. Although the allegation resident died due to staff neglect may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted where this report (LIC9099), was discussed and provided to Assistant Administrator Mary Gonzalez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 56-AS-20240213165029
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: 05/20/2025
NARRATIVE
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Medical records review dated 7/25/2023 confirmed R1 diagnosis and treatment of a fractured ankle. In addition, Department staff investigation revealed that R1 was placed in a splint and R1 physician requested skilled nursing placement on 07/28/2023. The Department staff investigation indicated that reappraisal was not required for R1 as staff at the facility reported the incident to R1's physician and requested for R1 to be seen after R1's fall.

The second allegation indicates facility did not have enough staff to meet the needs of resident in care. The Department staff interview with Staff #1 (S1) confirmed that R1 needs two-person transfer. Department staff reviewed R1 Individual Service Plan (ISP) completed on 9/26/2023 for the Assisted Living Waiver Program (ALW) stating R1 has a history of falling, uses a wheelchair and needs two-person transfer. Department staff investigations revealed that on 01/17/2024, R1's call light was on and S3 had gone to R1's room alone for assistance and arrived at the doorway to enter the room and heard R1 say, "diaper change" and could see R1 already moving to a standing position from R1's wheelchair and fell to the floor. S3 reported to Department staff that S3 had no time to try to catch or grab R1. Though the Department staff investigation revealed that it was only S3 who responded to R1's call light that resulted to R1's fall as R1's assigned caregiver Staff #4 (S4) was on lunch break, there was no indication that S3 attempted to assist and transfer R1. In addition, interview with S3 indicated that the incident happened so quickly that S3 did not even have time to put rubber gloves on. Department staff investigations revealed that S3 did not attempt to assist or transfer R1 as S3 reported knowing that R1 needs two-person assist. The Department staff interview with S2 indicated that S3 called for a Medication Technician (MedTech) to help with an emergency in R1's room and asked for 911 to be called after R1's fall and S2 did not provide information that S3 attempted to assist or transfer R1.

Therefore, based on the evidence obtained during the Department staff investigation, the allegation of staff did not reappraise resident as necessary (Allegation #1), and facility did not have enough staff to meet the needs of resident in care (Allegation #2) are UNSUBSTANTIATED at this time. Although the allegation staff did not reappraise resident as necessary (Allegation #1) and facility did not have enough staff to meet the needs of resident in care (Allegation #2) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted where this report (LIC9099) was discussed and provided to Assistant Administrator Mary Gonzalez. ***This is an amended report for the LIC9099 report issued on 05/20/2025***

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20240213165029
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
05/21/2025
Section Cited
CCR
87466
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87466 Observation of the Resident
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs...This requirement was not met as evidenced by:
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Licensee stated to train all staff on CCR 87466 and submit proof of all staff training log to LPA Brown by the Plan of Correction (POC) due date.
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Based on interview and records review, R1 sustained ankle fracture at facility which were not observed nor was R1 assisted with receiving care as needed which pose immediate health, safety, and personal rights risk to resident in care.
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Deficiency Dismissed
Type A
05/21/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient...This requirement was not met as evidenced by:
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Licensee stated to submit Personnel Report/Staff Schedule showing sufficient number of staffs working at the facility to provide the services necessary to meet residents that require two person assist and two person transfer to LPA Brown by the POC due date.
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Based on interview and records review, the Licensee did not comply with the section cited above by not ensuring that there are sufficient number of staffs to provide the services necesary to R1 needs which poses an immediate health, safety and personal rights risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5