336426760-1-3-2024-18-AS-RSTS-CZL33P-20240117165349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426760
Report Date: 01/18/2022
Date Signed: 01/03/2024 10:28:37 AM

Substantiated

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
01/10/2022 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220110092445

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: 32	DATE:	01/18/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Marilya Dunham		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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9

Staff left resident's in soiled clothing for extended periods of time

INVESTIGATION FINDINGS:

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13

Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced subsequent complaint visit to the facility. LPA met with Administrator Marlya Dunham on the purpose of this visit. During this investigation LPA conducted interviews with staff and residents; obtained supportive documentation for review to assist with determining the findings for the above noted allegations. The following was determined.

Allegation #1 – Staff left residents in soiled clothing for extended periods of time. LPA investigation consisted of an internal record review, interviews with staff (S1, S2) and residents (R1, R2, and R3), and LPA made observations. Staff interviews revealed that R1 would display uncooperative behavior to most staff when staff went to assist R1 with changing of their diaper. One staff interview admitted that R1 was, at times, not changed for 8 hours due to staff not feeling confident in changing R1, due to R1’s behaviors. Other staff interviews revealed that R1 was difficult to change, and due to this, R1 would not be changed on their shift.

Although LPA did not observe soiled linen, smell foul odor, nor observe any resident not being cared for otherwise during the investigation, staff interviews admitted that R1 was not being changed regularly due to their behaviors. LPA could not obtain relevant information through interviews with residents due to the residents’ cognitive state. Therefore, based on the interviews conducted, this allegation was Substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

During this visit, a Type A citation was issued, per the California Code of Regulations, Title 22 Division 6, chapter 8, Article 11.

An exit interview was conducted where a copy of this report, LIC9099D, LIC811, and Appeal Rights were provided to Ms. Dunham.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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 3

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
01/10/2022 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220110092445

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: 32	DATE:	01/18/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Marilya Dunham		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident's fell while in care
Resident sustained 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 subsequent complaint visit to the facility. LPA met with Administrator informed him/her on the purpose of this visit. During this investigation LPA conducted interviews with staff and clients; obtained supportive documentation for review to assist with determining the findings for the above noted allegations. The following was determined.

Allegation #1 – Resident's fell while in care. The Department received an allegation referring to Resident One (R1) falling in care due to lack of supervision by staff and sustaining an injury as a result of the fall. Staff interviews revealed that during the incident with R1, staff were attempting to change R1’s clothes, and R1 became resistant and sustained a fall and minor injury and R1 was later transported to the hospital. LPA conducted an internal record review and concluded that R1 had, been, in fact, sent to the hospital as a result of the incident. Therefore, based on interviews and record review, the allegation was Unsubstantiated.

Allegation #2 - Resident sustained injury while in care. Information was reported regarding Resident #1 (R1) who fell and hit their head sustaining a minor open wound on head and had a swollen knee. Interview with staff, and internal record review indicated that R1 had sustained a fall, and minor medical care was provided. It was further reported that a resident’s body, Resident #2 (R2) was moved back to their bed after being found by staff on the floor after they passed away. The Department conducted interviews with staff who were alleged to be present and found that R2 was found in their bed by staff and not on the floor, as alleged. The Department also conducted a review of the local Law Enforcement’s report which stated that R2 was found in their bed, and that the cause of R2’s death was deemed natural. Therefore, the allegation was Unsubstantiated.

Through the evidence obtained through the investigation, the Department determined the allegations were 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.

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 Ms. Dunham.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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-20220110092445

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 COURT	FACILITY NUMBER: 336426760
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/19/2022 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	87625(b)(3) Managed Incontinence - (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.	1 2 3 4 5 6 7	Licensee to develop a plan to address R1's incontinence needs and submit to LPA by 1/19/2022.
	8 9 10 11 12 13 14	This requirement is not being met as evidenced by: During LPA's investigation, LPA determined that R1 was not kept clean and dry by an episode of incontinence. This poses an immediate risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Reyna Lacey	TELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022

LIC9099 (FAS) - (06/04)

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