306005603-3-2-2023-22-AS-AORZ-CPXJQB-20230315071450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 03/02/2023
Date Signed: 03/02/2023 03:48:15 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
02/02/2023 and conducted by Evaluator Alvaro Ramirez Jr.

COMPLAINT CONTROL NUMBER: 22-AS-20230202112845

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: 87	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Citlali Galeana-Wellness Coordinator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was issued an unlawful eviction.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on 02/02/23. LPA was greeted and granted entry into the facility and met with Wellness Coordinator (WC) Citlali Galeana and explained the reason for the visit.

This agency has investigated the complaint alleging that resident was issued an unlawful eviction. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Five of eight individuals interviewed reported that Resident 1 (R1) got into a physical altercation with another resident on 01/29/23. Per Unusual Incident/Injury Report dated 01/31/23 R1 “punched R2 with a closed fist on left side of face” during a verbal altercation in the dining room. During the investigation LPA reviewed documents including the Resident Handbook and House Rules. The Resident Behavior Code section under the Resident Handbook and House Rules states the following: “The following behaviors…may result in a 30-day notice of termination of your Residency Agreement: Residents must not be disruptive…and must not be physically or verbally abusive to other residents or staff.”

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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 2

Control Number 22-AS-20230202112845

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 LIVING	FACILITY NUMBER: 306005603
	VISIT DATE: 03/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Records reviewed by LPA Ramirez included the facility Verbal Warning dated 06/20/22 and Citrus Hills Assisted Living Progress Notes for R1. Per facility Verbal Warning R1 violated “Quiet Hours” policy outlined in the Resident Handbook and House Rules for playing loud music “around 5:00AM.” Per Citrus Hills Assisted Living Progress Notes dated 09/09/22 during an altercation with another resident R1 grabbed and pinned another resident against the wall. LPA Ramirez reviewed the Resident Admission Agreement. Per Resident Admission Agreement facility may terminate the Agreement “for one or more of the following reasons: Failure of the Resident to comply with the general policies of the Community as outlined in the Resident Handbook…” On 01/30/23 facility issued a written eviction notice to R1 in alignment with regulatory requirements for Eviction Procedures as outlined in Tittle 22, Section 87224 Eviction Procedures. A copy of the eviction was sent to the Department on 01/30/23.

Therefore, based on interviews conducted and documents reviewed the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

LPA Ramirez conducted an exit interview with WC Galeana, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2