306005603-4-6-2023-22-AS-AORZ-CQTSYX-20230412141813

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 04/06/2023
Date Signed: 04/06/2023 04:35:42 PM

Unsubstantiated

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
03/15/2023 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230315110649

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: 88	DATE:	04/06/2023
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Itzayana Barba Aguirre-Operations Manager		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Resident was issued an unlawful eviction.
Resident was physically attacked by another resident due to lack of care and supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegations received on 03/15/23. LPA was greeted and granted entry into the facility and met with Operations Manager (OM) Itzayana Barba Aguirre and explained the reason for the visit.

This agency has investigated the complaint alleging that resident was issued an unlawful eviction and resident was physically attacked by another resident due to lack of care and supervision. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: 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.” LPA Ramirez reviewed the Resident Admission Agreement.
CONTINUED on LIC9099C...

Unsubstantiated

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: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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-20230315110649

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: 04/06/2023

NARRATIVE

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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…” Per Unusual Incident/Injury Report (UIR) dated 01/13/23 it was reported Resident 1 (R1) was physically assaulted by R2. During another incident, it was reported via Suspected Dependent Adult/Elder Abuse (SOC341) dated 03/13/23 that R1 was again physically assaulted this time by R3.

Per Facility’s Progress Notes for R1 dated 03/04/23 R1 was witnessed calling their roommate names and being verbally aggressive. Seven out of nine individuals interviewed reported that R1 can be problematic and verbally aggressive. On 03/14/23 facility issued a written eviction notice to R1 for verbal and physical altercations with other residents. The Department received a copy of the eviction notice on 03/14/23 and upon review determined it was not in alignment with regulatory requirements for Eviction Procedures as outlined in Tittle 22, Section 87224 Eviction Procedures because facility failed to properly document R1’s failure to comply with general policies of the facility.

Although incident reports received note R1 was involved in multiple physical altercations at the facility, incident reports describe R1 as the victim, not the aggressor. Although R1 was observed engaging in verbal altercations, it remains unclear at this time if incidents surmount to a violation of the house rules.

Regarding the allegation that resident was physically attacked by another resident due to lack of care and supervision, the investigation revealed the following: Per UIR dated 01/13/23 it was reported that R1 was physically assaulted by R2. During another incident, it was reported via SOC341 dated 03/13/23 that R1 was again physically assaulted this time by R3.

The facility reported a total census of eighty-nine residents. LPA reviewed a total of five resident files. Four of five resident files reviewed indicate that residents are ambulatory and require minimum assistance with activities of daily living (ADLs). Records reviewed included the staff schedule. On average there are two caregivers and one medication technician in the morning shift (6a.m.-2p.m), one caregiver and one medication technician in the evening shift (2p.m.-10p.m.), and one caregiver and one medication technician in the night shift (10p.m.-6a.m.). Six of nine individuals interviewed reported that facility staff are helpful and/or that facility has enough staff to care for residents. The remaining three individuals reported that facility is understaffed.

CONTINUED on LIC9099C...

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230315110649

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: 04/06/2023

NARRATIVE

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Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with OM Aguirre, 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: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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