306005603-5-15-2024-22-AS-AORZ-D5SMNR-20240531094559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 05/15/2024
Date Signed: 05/15/2024 04:14:01 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
02/23/2024 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240223161833

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:	05/15/2024
		UNANNOUNCED	TIME BEGAN:	02:31 PM
MET WITH:	Cindy Mora-Receptionist, Lynn Vuong-Business Office Manager		TIME COMPLETED:	04:28 PM

ALLEGATION(S):

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Staff do not assist resident with meeting medical needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on February 23, 2024. LPA was greeted and granted entry into the facility and met with receptionist Cindy Mora. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that staff do not assist resident with meeting medical needs. Resident 1 (R1) was admitted to the facility on September 27, 2022. Documents reviewed included the Physician Report (LIC602) dated March 27, 2024 for R1. Per Physician report R1's diagnoses are hemiplegia and bullous pemphigoid. Per the Mayo Clinic bullous pemphigoid is defined as a rare skin condition that causes large, fluid filled blister. During the course of the interviews with witnesses, Witness 1 (W1) reported that during an assessment on April 4th, 2024 that she did not noticed boils all over R1's body. During the course of the interviews with residents, R2 reported that she has not develop rashes or wounds and stated that staff would assist her if she needed to get medical attention.
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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-20240223161833

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: 05/15/2024

NARRATIVE

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During the investigation LPA reviewed documents including the Unusual Incident/Injury Report (UIIR) dated February 28, 2024 and March 8th 2024 for R1. Per the first UIIR on February 26, 2024 an ambulance was scheduled for R1 and R1 was transported to the ER for skin alteration. Per the second UIIR on February 29, 2024 Home Health Nurse recommended for R1 to be sent to the Hospital for skin alteration. Records reviewed by LPA included the Unison Health Services Home Health Plan of Care dated February 29, 2024 to April 28, 2024. Per Plan of Care Home Health staff will instruct on disease process of cellulitis and hemiplegia management and prevention of disease exacerbation and potential complications and importance of prompt reporting to the Primary Care Physician (PCP).

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 insufficient evidence. Therefore, the allegation has been deemed to be UNSUBSTANTIATED.

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

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

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