336426759-7-22-2021-18-AS-EMAN-C6F2W6-20210831174501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426759
Report Date: 07/22/2021
Date Signed: 07/22/2021 10:37:53 AM

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
08/28/2020 and conducted by Evaluator Natalie Gayoso

COMPLAINT CONTROL NUMBER: 18-AS-20200828113228

FACILITY NAME:	CITRUS GARDENS		FACILITY NUMBER:	336426759
ADMINISTRATOR:	KELLEY LARA		FACILITY TYPE:	740
ADDRESS:	25911 STANFORD ST		TELEPHONE:	(951) 925-7107
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	55	CENSUS:	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Diana Ramirez		TIME COMPLETED:	10:47 AM

ALLEGATION(S):

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Staff sexually abused resident while in care.
Staff threatened resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Gayoso conducted a complaint visit to deliver findings regarding the above allegations. LPA identified herself and discussed the purpose of the visit and the elements of the above allegations with Business Office Manager, Diana Ramirez.
The Department conducted investigation of the allegations to include interviews and records review. The allegation indicates staff sexually abused resident in care. Resident #1 (R1) was interviewed but would go off topic and could not recall the incident nor provide a description of the alleged perpetrator. Interviews with staff stated Resident #1 (R1) uses short phrases and/or gestures and hand motions to get point across when communicating with staff. Interviews also revealed that it was through hand gestures/motions and leading questions that staff interpreted that R1 was sexually abused. A full body check was conducted on R1 by a hospice nurse and no injuries were found per Riverside County Sheriff’s report. File review showed that R1 is diagnosed with dementia and schizophrenia. A review of R1’s Medication Administrator Record (MAR) revealed R1 was refusing to take their medication, including Divalproex that is prescribed to manage R1’s behaviors.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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-20200828113228

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: 07/22/2021

NARRATIVE

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The second allegation indicated staff threatened resident. Interview with Staff #4 (S4) revealed that they had reported allegation to Staff #5 (S5) and not to Staff #6 (S6). Interview with S5 confirmed that S4 reported the incident to them and the only individuals in the room while questioning R1 were S4 and S5, S6 was never present. S5 stated they have never witnessed S6 nor any other staff threaten R1.

Based interviews which were conducted, and record review, the allegations are unsubstantiated. A finding of UNSUBSTANTIATED means that 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 a copy of this report was provided to Ms. Ramirez.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

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