336426759-7-15-2021-18-AS-EMAN-C894LZ-20211028191245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426759
Report Date: 07/15/2021
Date Signed: 07/15/2021 12:46:51 PM

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
11/03/2020 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201103082715

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: 29	DATE:	07/15/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Shannon Hundley		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident's diapering needs are not being met.
Facility lacks adequate supplies needed to care for residents.
Staff did not provide timely food service to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility in order to deliver findings for the above allegations. LPA contacted the facility via telephone due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the call with Administrator, Shannon Hundley. The investigation consisted of interviews with staff/residents and records review.

In regards to allegation #1, LPA interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), Staff #4 (S4), and Staff #5 (S5) who all denied that residents diapering needs are not being met and they have not witnessed any residents being left in soiled diapers for long periods of time. All staff members that were interviewed stated that in regards to incontinence care protocol, residents are checked every two hours or as needed for those residents who have higher incontinent needs. LPA interviewed Resident #1 (R1) and Resident #2 (R2) who both stated that they have not witnessed any residents in soiled diapers or clothing.

In regards to allegation #2, LPA interviewed S1, S2, S3, S4, and S5 who all stated that the facility has

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021

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-20201103082715

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: 07/15/2021

NARRATIVE

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adequate Personal Protective Equipment, as well as, cleaning supplies and diapers for residents in care. LPA interviewed S1 and S2 who stated that the facility orders supplies such as gloves, cleaning supplies, and diapers through a supply company as often as needed. S1 and S2 denied any concerns of retrieving supplies for the facility. LPA Williams observed a sufficient amount of care supplies for residents in the facility.

In regards to allegation #3, LPA interviewed R1 and R2 who both stated that they are provided meals on time as scheduled. R1 and R2 did not recall an incident where meals were not provided on time. LPA interviewed S1 who stated that "meals are provided like clockwork." LPA also interviewed S2 who stated that they do not have any recollection of breakfast being served late or residents sitting at dining table with no food. LPA observed residents eating lunch at the time of visit.

Based on evidence obtained during today’s visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning 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 where this report (LIC 9099) was discussed and a copy was provided to Hundley.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021

LIC9099 (FAS) - (06/04)

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