306005603-2-16-2023-22-AS-AORZ-CPCMKF-20230224084041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 02/16/2023
Date Signed: 02/16/2023 03:33:18 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20230210113449

FACILITY NAME:	CITRUS HILLS ASSISTED LIVING		FACILITY NUMBER:	306005603
ADMINISTRATOR:	JUAN JORGE POEMAPE-DIAZ		FACILITY TYPE:	740
ADDRESS:	142 S PROSPECT ST		TELEPHONE:	(714) 639-3590
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	95	CENSUS: 85	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Itzy Barba		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Facility staff charged residents card without authorization.
Staff yelled at resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegations. LPA Lyman was allowed entry into the facility and met with Operations Manager (OM) Itzy Barba and explained the purpose of the visit.

During the course of the investigation, LPA interviewed staff and resident as well as reviewed and obtained pertinent documentation such as credit card authorization statement and admission agreement. Regarding the allegation that facility staff charged residents card without authorization and staff yelled at resident, the investigation revealed the following: Resident 1 (R1) signed an authorization for recurring automated credit card payment for rent. Signed authorization indicates agreement to deduct rent on the 1st day of each month. Staff 1 (S1) indicates verbal agreement for card authorization on the 4th day of the month as a courtesy to R1. On Saturday, February 4, 2023, R1's card was authorized for payment. Payment after the 5th day may result in a late fee. Per Reception (S2), R1 arrived at the front desk in the morning of the 4th yelling and agitated regarding credit card payment for rent and demanded the CONTINUED ON LIC 9099 C DATED 02/16/2023

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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 22-AS-20230210113449

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CITRUS HILLS ASSISTED LIVING	FACILITY NUMBER: 306005603
	VISIT DATE: 02/16/2023

NARRATIVE

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S1's personal phone number. Reception provided the number to R1. R1 contacted S1 by phone demanding the charges be reversed and stating would not be paying the rent. S1 reversed the charges and provided proof of the reversal to the resident. S1 requested a different method of payment the following Monday to which the staff was advised there would be no payment. S1 and S2 deny any yelling from themselves and state R1 was yelling at them about the rent payment and indicate residents present in the hallway could hear R1 yelling loudly. R1 had been given an eviction notice on 01/30/2023 for a verbal and physical altercation with another resident as it was the second incident. Per staff, R1 is declining to pay rent due to the pending eviction. Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

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