336426759-8-28-2023-18-AS-KCLS-CV8VMA-20230831163309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426759
Report Date: 08/28/2023
Date Signed: 08/28/2023 02:42:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/08/2022 and conducted by Evaluator Rayshaun Nickolas

COMPLAINT CONTROL NUMBER: 18-AS-20220908145705

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: 55	DATE:	08/28/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Diana Molina Ramirez, Executive Director		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Licensee failed to supervise resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas arrived at the facility unannounced to deliver findings on the above allegation. LPA Nickolas met with Wellness Coordinator Monica Quinones and explained the purpose of the visit. The Executive Director, Diana Molina Ramirez, would arrive at the facility later. The investigation included file reviews, a tour of the facility, and interviews with relevant parties.

The allegation alleged that on September 7, 2022, client #1 (C1) jumped out of the window and eloped from the facility. The allegation alleged that during a routine check at the facility, staff #1 (S1) was notified by another client that C1 jumped out of the window. LPA Nickolas’ interview with staff #2 (S2) and staff #3 (S3) revealed that they were not present when the incident occurred. LPA Nickolas’ interview with C1 revealed that C1 could not participate in the interview process. LPA Nickolas’ file reviews revealed that the facility had sufficient staff working the night of the incident. LPA Nickolas' file reviews revealed that the facility notified law enforcement and law enforcement responded within an hour of C1 being reported missing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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-20220908145705

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: CITRUS GARDENS	FACILITY NUMBER: 336426759
	VISIT DATE: 08/28/2023

NARRATIVE

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LPA Nickolas' file reviews also revealed that the facility notified C1's relative 30 minutes after C1 was discovered missing and reported the incident to the Community Care Licensing Division (CCLD) within the regulatory timeframe. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and copy of this report was provided.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC9099 (FAS) - (06/04)

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