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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880924
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:16:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/15/2021 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 18-AS-20211215084528
FACILITY NAME:CITRUS PLACEFACILITY NUMBER:
331880924
ADMINISTRATOR:SPENCER, LORIFACILITY TYPE:
740
ADDRESS:7898 CALIFORNIA AVENUETELEPHONE:
(951) 687-2241
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:140CENSUS: 117DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Vicky TorresTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Resident's ceiling is in disrepair
Resident's electricity is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kimberly Lyman and Joseph Alejandre conducted an unannounced complaint visit to continue the investigation into the above allegations. LPA s were greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPAs toured the facility and interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as facility emails. Regarding the allegations that resident's electricity is in disrepair and resident's ceiling is in disrepair, the investigation revealed the following: Resident 1 (R1) had a leak in the ceiling of the living room of the resident's apartment. Facility documentation indicated an ongoing issue with leaks with the initial leak in October 2021. A new leak occurred in December 2021 and facility documentation shows facility was taking steps to address the leak. Executive Director at time of complaint indicated an issue with water in light switches resulting in the breaker turning off. LPAs observed through documentation that the leak and repair was extensive. LPAs observed repaired ceiling during today's visit. Based on records reviewed and interviews conducted, the allegations are deemed substantiated. Citations are being cited in accordance CONT ON LIC 9099C DATED 11/19/24

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 18-AS-20211215084528
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CITRUS PLACE
FACILITY NUMBER: 331880924
VISIT DATE: 11/19/2024
NARRATIVE
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with the California Code of Regulations (Title 22, Division 6, Chapter 8). Exit interview conducted and a copy of this report as well as appeal rights are being provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20211215084528
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CITRUS PLACE
FACILITY NUMBER: 331880924
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/03/2024
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This req is not being met as evidenced by:
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LPA observed the ceiling has been repaired in R1's room. CLEARED DURING VISIT.
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Based on interviews conducted and record review, the Licensee failed to ensure facility was safe and in good repair. Facility had an ongoing issue with ceiling leaks in R1's room. This poses a potential health and safety risk to residents in care.
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Type B
12/03/2024
Section Cited
CCR
87307(d)(2)
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The following space and safety provisions shall apply to all facilities:
The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This req is not being met as evidenced by:
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Licensee to submit a statement of understanding of the regulation and forward proof to LPA by POC due date.
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Based on record review and interviews conducted, Licensee failed to ensure R1's room was safe and healthful. Facility documentation indicates an issue with water being inside the light sockets in R1's room. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3