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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426759
Report Date: 05/23/2022
Date Signed: 05/23/2022 11:14:03 AM


Document Has Been Signed on 05/23/2022 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 GARDENSFACILITY NUMBER:
336426759
ADMINISTRATOR:TRACY LANGENDOENFACILITY TYPE:
740
ADDRESS:25911 STANFORD STTELEPHONE:
(951) 925-7107
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:55CENSUS: 51DATE:
05/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Diana Ramirez, AdministratorTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Javina George arrived at the facility unannounced for the purpose of a complaint investigation (#18-AS-20220520121929). LPA was greeted and granted entry by receptionist Marisol Torres. Administrator arrived an hour after LPAs arrival. During today's inspection, LPA George observed the following deficiencies:

LPA George reviewed the copy of the personnel roster obtained from the Licensing Information System (LIS) and observed that Staff #1 (S1) was not associated to the facility. Deficiency cited.

To have an individual work at the facility without proper background clearance (or completion of transferring clearance) results in civil penalties in the amount of $100 per day, per individual.

LPA George will be issuing civil penalties in the maximum amount of $500 ($100 per day x 5 days) during today's inspection for S1 $500.

In addition LPA requested resident files, to conduct a review and the files were not readily available. LPA waited for 40 minutes for the resident files that were requested. A Deficiency will also be cited.

LPA George conducted an exit interview with Diana Ramirez, Administrator and a copy of this report, LIC809D, LIC421BG, and appeal rights were also provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 05/23/2022 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2022
Section Cited

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Criminal Record Clearance: (e) All individuals...shall prior to working, residing or volunteering in a licensed facility: (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by:
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Based on observation the Licensee did not comply with the above regulation with at least one staff (S1). LPA George learned that S1 is not associated to this facility. This is an immediate safety risk to all residents in care.
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Type B
06/06/2022
Section Cited

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87506 Resident Records
d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements...
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This requirement is not met as evidenced by LPA making the request and having to wait for 40 minutes. This is a potential health, safety or personal rights risk.
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The licensee agrees to conduct an inservice on Resident records. Proof is to be submitted by 5pm on the due date indicated.
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: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
LIC809 (FAS) - (06/04)
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