306005603-3-1-2024-22-AS-AORZ-D5PRX5-20240528132404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 03/01/2024
Date Signed: 03/01/2024 03:23:34 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-20240223130422

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: 83	DATE:	03/01/2024
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Maintenance Director-Ryan Mims		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not ensure resident’s room is adequately cleaned.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA Ramirez was greeted and allowed entry into the facility and met with Maintenance Director Ryan Mims. LPA explained the purpose of the visit.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Eight of nine individuals interviewed denied the allegation. During the investigation LPA reviewed documents including the Resident Admission Agreement dated 07/28/23 for Resident 1 (R1). Per Admission Agreement for R1 under Basic Services number 1.1.8. it states weekly housekeeping, to include vacuuming of carpets, mopping of floors,...and emptying the trash. Per Basic Services under 1.1.9. clean bed and bath linen weekly. Records reviewed by LPA Ramirez included the Housekeeping Log for R1.
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: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

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-20240223130422

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: 03/01/2024

NARRATIVE

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Per Housekeeping Log R1's bedroom is being cleaned more than once per week. During the interviews with residents, R1 reported that their bedroom is cleaned and stated that the Housekeeping staff is a good person. Per R1 their bedroom does not smell like urine and/or feces. During the interviews with staff, Staff 1 (S1) reported that she cleans R1's bedroom daily and stated that she takes out the trash daily. During the initial visit on 03/01/24 LPA observed that R1's bedroom was adequately cleaned and observed that the trash cans were empty. During the initial visit LPA toured R1's bedroom and did not smell any malodorous smells.

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.

An exit interview was conducted with facility representative and a copy of this report was provided at the time of exit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

LIC9099 (FAS) - (06/04)

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