306005603-12-11-2024-22-AS-MSTC-DCC2MA-20241226163050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 12/11/2024
Date Signed: 12/11/2024 03:48:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/10/2024 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240910121745

FACILITY NAME:	CITRUS HILLS ASSISTED LIVING		FACILITY NUMBER:	306005603
ADMINISTRATOR:	ITZAYANA BARBA AGUIRRE		FACILITY TYPE:	740
ADDRESS:	142 S PROSPECT ST		TELEPHONE:	(714) 639-3590
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	95	CENSUS: 80	DATE:	12/11/2024
		UNANNOUNCED	TIME BEGAN:	01:14 PM
MET WITH:	Charlie Marinko-Executive Director		TIME COMPLETED:	04:09 PM

ALLEGATION(S):

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Staff did not prevent outbreak of bedbugs.
Staff damaged and did not return resident’s personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on September 10, 2024. LPA was greeted and granted entry into the facility and met with Executive Director (ED) Charlie Marinko. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that staff did not prevent outbreak of bedbugs and staff damaged and did not return resident’s personal belongings. Resident 1 (R1) was admitted to the facility on April 29, 2022. Documents reviewed included the Physician Report (LIC602) dated April 29, 2022 for R1. Per Physician report R1’s diagnosis is Lumbar stenosis. Regarding the allegation that staff did not prevent outbreak of bedbugs, the following was revealed: During the investigation LPA reviewed documents including the Terminix Commercial invoices dated January 30, 2024, to July 03, 2024. Per Terminix Commercial invoice during these visits Terminix conducted a general pest control inspection. Documents reviewed included the Pestprotection Pest Control invoices dated June 10, 2024,
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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-20240910121745

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CITRUS HILLS ASSISTED LIVING	FACILITY NUMBER: 306005603
	VISIT DATE: 12/11/2024

NARRATIVE

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to September 11, 2024. Per Pestprotection Pest Control dated June 10, 2024 it states inspect entire 1st floor and 2nd floor for bedbug activity to determine where the bedbugs are active. Per Pestprotection Pest Control dated June 14, 2024 it states vacuum entire unit cracks and crevices, bed frames, baseboards and apply a treatment for the control of bedbugs where live bedbug activity was detected. Per Pestprotection Pest Control dated September 18, 2024 to December 06, 2024 it states apply crawling insect prevention to the interior and exterior perimeters of the building and/or applied bedbug control. During the course of the interviews with residents, R2 reported that they have not seen bedbugs in the facility and stated that the exterminator comes monthly.

Regarding the allegation that staff damaged and did not return resident’s personal belongings, the following was revealed: Documents reviewed included the Resident Personal Property and Valuables (LIC621) dated May 03, 2022 for R1. Per Resident Personal Property Valuables R1's personal property include an Insignia television, two cellphones and a wheelchair. During the course of the interviews, R1 reported that in April 2024 the facility brought in professional exterminators and stated that they bagged his clothes while inspecting his unit. Per R1 staff lost 11 of his shirts, shorts and socks. LPA reviewed documents including the Citrus Hills Assisted Living A/R Change Form dated January 11, 2024. Per A/R Change Form R1 received a discount/credit for $299 for personal items. Per R2 staff have not damage or taken his personal property. R2 reported that he has not had issued with staff and stated that staff are helpful.

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

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.

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

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC9099 (FAS) - (06/04)

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