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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426760
Report Date: 12/08/2022
Date Signed: 12/08/2022 09:42:44 AM

Unsubstantiated


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
11/05/2021 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211105103544
FACILITY NAME:CITRUS COURTFACILITY NUMBER:
336426760
ADMINISTRATOR:MARLYA DUNHAMFACILITY TYPE:
740
ADDRESS:161 N HEMET STTELEPHONE:
(951) 927-6817
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:66CENSUS: 14DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Marlya Dunham, AdministratorTIME COMPLETED:
09:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not prevent resident from falling while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jesse Gardner arrived to deliver the findings for the above complaint allegation. LPA met with Administrator Marlya Dunham. LPA toured the facility, interviewed staff and residents, and reviewed facility records.
An allegation was received stating facility staff did not prevent resident from falling while in care. Through interviews with S1 & S2 it was discovered that on 10/23/21 while S1 was in R1’s bedroom, R1 fell from the wheelchair. S2 heard the commotion and came into the bedroom to assist S1 with the resident. S1 stated R1’s lips were “bluish purple and that R1 was not responsive.” 911 was contacted and R1 was sent to the hospital as a result of the fall. A review of R1's records revealed that although R1 utilized a wheelchair to ambulate, her ability to ambulate was not dependent on caregiver assistance. An attempt to interview R1 was made but was unsuccessful due to R1’s cognitive abilities.
Based upon the investigation the allegation that facility staff did not prevent resident from falling while in care is unsubstantiated. R1 appeared to be having a medical emergency resulting in a spontaneous fall from the wheelchair. Staff was in the room and the time of the incident and responding immediately to R1. Therefore, based upon the investigation the allegation is 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.

An exit interview was conducted, and a copy of this report was provided.

This is an amended version of the original report created on 1/3/2022.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
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
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
11/05/2021 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211105103544

FACILITY NAME:CITRUS COURTFACILITY NUMBER:
336426760
ADMINISTRATOR:MARLYA DUNHAMFACILITY TYPE:
740
ADDRESS:161 N HEMET STTELEPHONE:
(951) 927-6817
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:66CENSUS: 14DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Marlya Dunham, AdministratorTIME COMPLETED:
09:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was sexually abused 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 deliver the findings of the above allegation. During the investigation the Department conducted interviews with the Administrator and resident 1 (R1) and obtained copies of facility records.
An allegation was received stating resident was sexually abused while in care. Interview with Administrator (A1) revealed resident was admitted to the facility two years ago with a chronic condition and denied knowledge of anyone touching R1 inappropriately. A1 stated the condition is chronic and when the condition flares up R1 is seen by the doctor. In addition, the facility provided two medical reports dated March 10, 2021 and May 11, 2021, which documents the residents condition as chronic. During an interview with R1, resident denied allegations of any inappropriate touching by other individuals.
Based upon the investigation, the allegation that resident was sexually abused while in care is unfounded. A finding of UNFOUNDED means that the allegations were false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided along with a copy of the LIC811 (confidential names list).

This is an amended version of the original report created on 1/3/2022.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2