336426759-12-8-2022-18-AS-JESL-CNM4SC-20230131182117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426759
Report Date: 12/08/2022
Date Signed: 12/08/2022 09:32:54 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/07/2022 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221207131235

FACILITY NAME:	CITRUS GARDENS		FACILITY NUMBER:	336426759
ADMINISTRATOR:	TRACY LANGENDOEN		FACILITY TYPE:	740
ADDRESS:	25911 STANFORD ST		TELEPHONE:	(951) 925-7107
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	55	CENSUS: 49	DATE:	12/08/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Deanna Lewis, LVN		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Resident developed multiple pressure injuries while in care

Resident is being unlawfully evicted

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initiating an investigation with the above allegation. LPA Colvin met with LVN Deanna Lewis and informed her of the purpose of today's inspection. Below is a summary of the findings:

Regarding allegation "Resident developed multiple pressure injuries while in care ": LPA Colvin requested a current resident roster for the facility and observed that the resident (R1) that is the subject of this complaint is not listed. LPA Colvin interviewed two supervising staff regarding R1, and both stated that they did not recognize the name and that R1 never lived at the facility. Since LPA Colvin was able to confirm that R1 is not and was not a resident of the licensed facility, the allegation "Resident developed multiple pressure injuries while in care" is UNFOUNDED.

Regarding allegation "Resident is being unlawfully evicted": LPA Colvin was able to determine through record review and interview that the subject of the complaint (R1) is not and was not a resident of this facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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 18-AS-20221207131235

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CITRUS GARDENS	FACILITY NUMBER: 336426759
	VISIT DATE: 12/08/2022

NARRATIVE

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Since R1 is/was not a resident of a licensed facility, the Department does not have any jurisdiction over this matter, and the allegation "Resident is being unlawfully evicted" is UNFOUNDED.

The Department conducted an investigation of the above allegations, which were determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without reasonable basis. We have therefore dismissed the complaint.

An exit interview conducted and a copy of this report provided to LVN Deanna Lewis.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC9099 (FAS) - (06/04)

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