306005603-1-23-2025-22-AS-AJLO-DDFRLC-20250131120654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 01/22/2025
Date Signed: 01/23/2025 09:07:57 AM

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
10/28/2024 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241028095754

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: 85	DATE:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	11:24 AM
MET WITH:	Angelica Perez Penate-Clinical Director		TIME COMPLETED:	04:08 PM

ALLEGATION(S):

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Staff inappropriately had resident sign documents without authorized representative knowledge.
Licensee has changed residents' health insurance for financial gain.

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 October 28, 2024. LPA was greeted and granted entry into the facility and met with Clinical Director (CD) Angelica Perez Penate. LPA explained the reason for the visit.

This Department has investigated the complaint alleging staff inappropriately had resident sign documents without authorized representative knowledge. Regarding the allegation the following was revealed: During the course of the interviews with residents, Resident 1 (R1) reported that he signed his health insurance documents with his consent. Per R1 he switched to a better insurance. Per R3 he signs his own documents and reported that he has not changed his health insurance. During the course of the interviews with staff, Staff 1 (S1) reported that the residents chose their new insurance and stated that the facility is here to protect the residents' Health and Safety. During the course of the investigation LPA reviewed documents including the Citrus Hills Assisted Living Health Care Change dated October 22, 2024, for R1.
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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-20241028095754

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: 01/22/2025

NARRATIVE

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Per Health Care Change for R1 it states starting immediately we give our permission to have R1's health care management be rendered by Senior Doc personnel and their associates. The Health Care Change was signed on October 22, 2024, by R1's conservators. Documents reviewed included the Citrus Hills Assisted Living Health Care Change dated October 23, 2024, for R2. Per Health Care Change it states management company Gnosis Geriatric Wellness Center and it's associated persons and affiliates are required to stop all treatment, assessment and visitations. The Health Care Change was signed on October 23, 2024, by R2. LPA reviewed documents including the Citrus Hills Assisted Living Move In Record dated October 14, 2022, for R3. Per Move In Record R3's Primary Care Physician (PCP) is listed as Gerardo Canchola. Per National Provider Identifier Database Gerardo Canchola is listed as the Medical Director for Gnosis Geriatric Wellcare Center Inc.

Regarding the allegation that Licensee has changed residents' health insurance for financial gain, the following was revealed: During the course of the interviews six of seven individuals denied the allegation and/or stated not being aware if the facility changed the residents' health insurance for financial gain. During the course of the investigation LPA observed that R1, R2 and/or their conservators signed a Health Care Change statement when changing their health insurance. During the investigation LPA observed that R3 has not changed their health insurance. During the course of the interviews with staff, S1 reported that the Licensee has not changed the resident's health insurance for financial gain and stated that the resident with a Power of Attorney (POA) had their POA signed.

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, these 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 facility representative, 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: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC9099 (FAS) - (06/04)

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