331880924-12-29-2023-18-AS-JARA-CYYRQV-20231229121411

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880924
Report Date: 12/29/2023
Date Signed: 12/29/2023 12:14:28 PM

Document Has Been Signed on 12/29/2023 12:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR:	SPENCER, LORI		FACILITY TYPE:	740
ADDRESS:	7898 CALIFORNIA AVENUE		TELEPHONE:	(951) 687-2241
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	140	CENSUS: 103	DATE:	12/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Administrator, Lori Spencer		TIME COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA was greeted and was granted entry and met with Administrator Lori Spencer who was informed of the purpose of the visit. At the time of the visit the facility has (8) cases of residents who are positive for COVID-19, Personal Protective Equipment (PPE) and precautions were taken during the visit. LPA conducted a tour of the interior and exterior, reviewed facility documents, and observed the following: The facility licensed with the department is comprised of (2) buildings. Memory care which is a one story building and the assisted living facility is a two story. The facility does have a pool which has a locked gate surrounding it. No fire arms are kept at the facility. The facility is designated as a residential care facility for the elderly serving elderly ages (60) and above. Infection Control: LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA observed facility residents in isolation who are positive for COVID-19 with PPE equipment outside their rooms, and meals that are being provided to their rooms. LPA was informed staff are encouraging resident to wear PPE and LPA observed staff wearing PPE while around the residents. The facility has reported the infectious disease to the department, and have a plan on mitigating the spread of infectious diseases. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The facility has carbon monoxide alarms which were located during the time of the visit. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required food supplies to meet resident's needs.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/29/2023

NARRATIVE

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Record Review and Resident/Staff Files: LPA reviewed staff files, training, and staff criminal clearance, client files were also reviewed for memory care and assisted living residents. The administrator's file was reviewed which met the department requirements. All required and up to date paperwork.

Health Related Services/ Incidental Medical Services: All client medication was locked in a medication room and medications carts. Medication was accounted for and LPA observed staff passing medications and observed the facility has the new cycle of medication for all residents. Centrally stored lists of medications for (5) residents were reviewed.

Disaster preparedness: The facility has an emergency and disaster plan. LPA reviewed documentation showing last fire drill conducted 12/22/23. LPA observed all facility exits were clear from obstructions and the facility possess the required evacuation chairs at stairways.

No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to Administrator, Lori Spencer.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023

LIC809 (FAS) - (06/04)

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