336426760-10-27-2023-18-AS-RSTS-CXF36K-20231109165827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426760
Report Date: 10/27/2023
Date Signed: 10/27/2023 02:24:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
12/30/2021 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211230152555

FACILITY NAME:	CITRUS COURT		FACILITY NUMBER:	336426760
ADMINISTRATOR:	MARLYA DUNHAM		FACILITY TYPE:	740
ADDRESS:	161 N HEMET ST		TELEPHONE:	(951) 927-6817
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	66	CENSUS: 20	DATE:	10/27/2023
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Marlya Dunham, Adminsitrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff speak inappropriately to residents.
Facility staff did not seek medical attention for resident in a timely manner.
Resident sustained unexplained injury while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Jesse Gardner, conducted an unannounced visit to the facility to commence a complaint investigation on the above allegations. LPA was met by Activities Director Lisa Mathews who was informed of the purpose of the visit.

Regarding the allegation, "Facility staff speak inappropriately to residents", it was alleged that staff yelled at a resident due to having to clean up after them after they were not able to make it to the restroom on time. LPA conducted interviews with residents (R1, R2, and R3) and Staff #1 (S1). All of the interviews concurred that staff did not speak inappropriately to residents; thus the allegation is deemed UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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 2

Control Number 18-AS-20211230152555

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CITRUS COURT	FACILITY NUMBER: 336426760
	VISIT DATE: 10/27/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation, "Facility staff did not seek medical attention for resident in a timely manner", LPA conducted interviews with staff and R1, who was reportedly bleeding from an open bruise on their arm. Staff interview revealed that R1’s injury was dressed in a bandage. However, records to corroborate this notion were not able to be reviewed. Interview with R1 indicated that R1 had never been injured while at the facility. Thus, the allegation is deemed UNSUBSTANTIATED.

Finally, regarding the allegation, "Resident sustained unexplained injury while in care". It was alleged that R1 has sustained bruises on their arms from an unknown source. Interviews with staff indicated that R1 is very active in their wheelchair and will often bump into doorframes causing bruising on their arms. Staff further indicated that their needs are attended to. An interview with R1 revealed that R1 had never been injured while at the facility. Through interviews conducted with staff and residents, this allegation is UNSUBSTANTIATED. During this visit, no citations were issued, as no deficiencies were noticed per the California Code of Regulations, Title 22.

An exit interview was conducted where a copy of this report, and LIC811, were provided to Mrs. Dunham.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2