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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426759
Report Date: 09/06/2023
Date Signed: 09/06/2023 02:59:11 PM

Substantiated


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
08/20/2020 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200820154620
FACILITY NAME:CITRUS GARDENSFACILITY NUMBER:
336426759
ADMINISTRATOR:KELLEY LARAFACILITY TYPE:
740
ADDRESS:25911 STANFORD STTELEPHONE:
(951) 925-7107
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:55CENSUS: 54DATE:
09/06/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Diana Molina Ramirez, Executive DirectorTIME COMPLETED:
03:06 PM
ALLEGATION(S):
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Hazardous items accessible to residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegation. LPA met with Ashlee Theus and explained the purpose of the visit. The Executive Director Diana Molina Ramirez, later arrived at the faciliy. Department staff investigated the above allegation, and LPA Nickolas also conducted facility tours, file reviews, and additional interviews pertinent to this investigation.

The allegation alleged that cleaning products are left out for residents to access. On August 7, 2023, LPA Nickolas conducted a facility tour with staff #1 (S1) and discovered a bottle of cleaning solution in an unsecured credenza located in Villa 2. LPA Nickolas questioned S1 about the cleaning solution. S1 stated they did not know why the solution was not placed in the secured cabinet. S1 questioned an unidentified member of the facility staff working in that building, and that staff stated that it was there when they arrived.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
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 6
Control Number 18-AS-20200820154620
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: 09/06/2023
NARRATIVE
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 Based on the evidence gathered during the investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An exit interview was conduct were a copy of this report (LIC 9099), LIC 9099D, and appeal rights were discussed and provided.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20200820154620
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2023
Section Cited
CCR
873099(a)
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87309 Storage Space (a)
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

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The Licensee shall provide training on the cited regulation section to all facility staff. The Licensee shall also provide proof of training with all employee signatures to the Regional Office (RO) by the POC due 09/29/2023.
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This requirement was not met, as evidenced by the following.

Based on observation, the facility did not ensure to store cleaning solutions inaccessible to clients.
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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.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
08/20/2020 and conducted by Evaluator Rayshaun Nickolas
COMPLAINT CONTROL NUMBER: 18-AS-20200820154620

FACILITY NAME:CITRUS GARDENSFACILITY NUMBER:
336426759
ADMINISTRATOR:KELLEY LARAFACILITY TYPE:
740
ADDRESS:25911 STANFORD STTELEPHONE:
(951) 925-7107
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:55CENSUS: 54DATE:
09/06/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Diana Molina Ramirez, Executive DirectorTIME COMPLETED:
03:06 PM
ALLEGATION(S):
1
2
3
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Facility in disrepair
Staff did not provide activities for residents.
Staff did not safeguard residents’ medical equipment.
Staff not providing resident with comfortable bed accommodations.
Facility not prepared for emergencies.
Staff did not check on resident in a timely manner.
Staff engaging in inappropriate behaviors in the presence of residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegation. LPA met with Ashlee Theus and explained the purpose of the visit. The Executive Director Diana Molina Ramirez, later arrived at the faciliy. Department staff investigated the above allegation, and LPA Nickolas also conducted facility tours, file reviews, and additional interviews pertinent to this investigation.

Allegation #1 “Facility in disrepair”. The allegation alleged that the facility has holes in the walls, broken window parts, broken chairs, the toilets have no lids, and wires hanging everywhere. LPA Nickolas' interviews with several facility staff members revealed that they denied this allegation. LPA Nickolas' facility tour revealed no evidence of holes in the walls, broken window parts, broken chairs, missing toilet lids, and wires everywhere. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20200820154620
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: 09/06/2023
NARRATIVE
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Allegation #2 “Staff did not provide activities for residents. The allegation alleged that the facility had not provided activities for the residents in care for at least three (3) months. LPA Nickolas’ interview with the Executive Director revealed that the facility has an activities director, and the activities director has an assistant. LPA Nickolas' interviews with several clients in care revealed that although numerous interviews were attempted with clients in care, only one (1) client, client #2 (C2), could discuss some of the activities provided at the facility. LPA Nickolas' interview with C2 revealed that the facility offers bingo and movie nights. LPA Nickolas' facility tour revealed that several activity calendars are posted throughout the facility. The facility's activity calendars list two (2) or three (3) activities every day for August and September 2023. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #3 “Staff did not safeguard residents’ medical equipment”. The allegation alleged that the facility staff did not safeguard the client’s medical equipment. LPA Nickolas’ interviews with several facility staff members revealed that they denied this allegation. LPA Nickolas’ interviews with several clients in care revealed that the clients expressed no concern about living at the facility or could not participate in the interview process. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #4 “Staff not providing resident with comfortable bed accommodations”. The allegation alleged that the client's air mattress setting was not correct. Department staff interview with staff # 1 (S1) revealed that the hospice agency checks the settings on the air mattresses. LPA Nickolas’ interview with the Executive Director revealed that hospice orders the air mattresses, and hospice sets the setting on the mattresses, not facility staff. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #5 “Facility not prepared for emergencies” The allegation alleged that the facility had no backup plan during a power outage. The allegation alleged that during an active shooter in the area, the facility staff failed to lock down the facility but were outside trying to see what was happening. Department staff interview with S1 revealed that they were not provided active shooter training. LPA Nickolas’ interview with the Business Office Manager revealed that the Business Office Manager denied this allegation. The Business Office Manager stated the facility has generators and discussed the facility’s active shooter training. LPA Nickolas' interview with two (2) facility staff members acknowledged receiving active shooter training and were able to discuss that training. LPA Nickolas reviewed the facility’s active shooter training and emergency disaster plan. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20200820154620
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: 09/06/2023
NARRATIVE
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Allegation #6 “Staff did not check on resident in a timely manner”. The allegation alleged that on numerous occasions, client #1 (C1) activated their call button and waited over an hour, and no one came to assist them. LPA Nickolas' interview with the Business Office Manager revealed that they denied this allegation. LPA Nickolas' interviews with several clients in care revealed that some clients could articulate they do not wait long for staff to assist them. While other clients' interviewed were not able to participate in the interview process. LPA Nickolas' interviews with several caregivers revealed that they denied this allegation. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #7 “Staff engaging in inappropriate behaviors in the presence of residents”. The allegation alleged unidentified facility staff members were fighting in the facility’s garden. Department staff interview with S1 and staff #2 (S2) revealed that they denied this allegation. LPA Nickolas’ interview with an additional four (4) facility staff members denied this allegation. 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 ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6