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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005603
Report Date: 02/14/2023
Date Signed: 02/14/2023 04:42:17 PM


Document Has Been Signed on 02/14/2023 04:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CITRUS HILLS ASSISTED LIVINGFACILITY NUMBER:
306005603
ADMINISTRATOR:JUAN JORGE POEMAPE-DIAZFACILITY TYPE:
740
ADDRESS:142 S PROSPECT STTELEPHONE:
(714) 639-3590
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:95CENSUS: 83DATE:
02/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Operations Manager-Itzayana Barba AguirreTIME COMPLETED:
04:56 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Alvaro Ramirez, Jr. and Patricia Velazquez conducted an unannounced visit to Citrus Hills Assisted Living. LPAs Ramirez and Velazquez were allowed entry into the facility and met with Operations Manager (OM) Itzayana Barba Aguirre. The purpose of this Case Management visit was to deliver an amended Complaint report with Complaint Control Number 22-AS-20230112164247. A Type A deficiency was cited on the amended report and an immediate $500 Civil Penalty was issued.


On 01/27/23 the Plan of Correction was submitted to LPA Alvaro Ramirez, Jr. The deficiency was cleared on that date. Plan of Correction letter was provided at the time of this Case Management visit.



There were no deficiencies issued during this Case Management visit. An exit interview was conducted with Operations Manager Aguirre and Wellness Director (WD) Yairell Garcia a copy of this report was provided at the time of exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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