336426760-9-8-2021-18-AS-EMAN-C74STQ-20210922140955

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426760
Report Date: 01/26/2021
Date Signed: 09/08/2021 01:29:25 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
07/29/2020 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200729121503

FACILITY NAME:	CITRUS COURT		FACILITY NUMBER:	336426760
ADMINISTRATOR:	KELLEY LARA		FACILITY TYPE:	740
ADDRESS:	161 N HEMET ST		TELEPHONE:	(951) 927-6817
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	66	CENSUS: 35	DATE:	01/26/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Kelley Lara		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff failed to provide a comfortable temperature for residents while in care
Staff failed to ensure safety measures are put in place for residents while in care
Staff failed to properly report incidents regarding residents
Staff fail to prevent a resident from hitting other residents while in care
Staff do not have planned activities for residents
Staff spoke inappropriately towards a resident while in care
Staff is not present for a significant time at the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility to initiate a complaint investigation into the above allegations via telephone due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the call with Administrator, Kelley Lara. The investigation consisted of interviews with staff/residents and records review.

In regards to allegation #1, LPA interviewed Resident #1 (R1) and Resident #2 (R2) who both stated that the facility operates in comfortable temperatures. Both R1 and R2 also stated that the facility accommodates residents with fans, heaters, and/or blankets in the case that a resident is too cold or warm. LPA reviewed documentation which showed that the air conditioning unit had been serviced and was working appropriately during visits.

In regards to allegation #2, LPA interviewed Staff #1 (S1) who stated that the facility is not a memory care facility so there is not a locked perimeter in place; however, due to the COVID-19 pandemic, the doors are

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: 01/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021

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

Control Number 18-AS-20200729121503

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
	VISIT DATE: 01/26/2021

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	An exit interview was conducted where this report was discussed and a copy was provided to Lara via email.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 18-AS-20200729121503

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
	VISIT DATE: 01/26/2021

NARRATIVE

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locked to allow for proper screening of visitors. S1 stated that there has not been any issues of residents wandering. LPA interviewed R1 and R2 who both stated they feel safe at the facility.

In regards to allegation #3, LPA interviewed S1 and Staff #2 (S2) who both stated that incidents regarding residents are reported to appropriate agencies/responsible parties. S2 stated that incident reports such as, falls and injuries, are reported to the physician, responsible party, and Community Care Licensing (CCL). LPA reviewed the department's incident report log which showed numerous incidents that were reported by the facility to the CCL regional office.

In regards to allegation #4, LPA interviewed Staff #1 (S1) who stated that they had an incident where Resident #3 (R3) attempted to hit another resident; however, R3 was redirected and advised not to hit other residents. LPA interviewed R1 and R2 who both denied there are residents hitting each other.

In regards to allegation #5, LPA interviewed R1 and R2 who stated that there are activities for the residents such as, bingo, board games, crafts, and exercise. LPA interviewed S1 and Staff #3 (S3) who stated that the facility conducts activities for the residents and they usually follow the activity calendar. LPA reviewed the facility's activity calendar which showed that there were a variety of activities for residents on a daily basis.

In regards to allegation #6, LPA interviewed R1 and R2 who both stated that they have not been spoken to inappropriately to by a staff member nor have they witnessed it towards any other resident. LPA interviewed S1, S2, and S3 who all denied speaking to or witnessing a staff member speaking inappropriately to any resident.

In regards to allegation #7, LPA interviewed R1 and R2 who stated that the administrator is always at the facility. R1 and R2 also both states that they believe the facility has sufficient staffing levels. LPA interviewed S3 who stated that the administrator is at the facility Monday through Friday and sometimes on the weekends. S3 also stated that the administrator is usually readily available for staff and residents.

Based on evidence obtained during today’s tele-visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021

LIC9099 (FAS) - (06/04)

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