306005603-9-12-2022-22-AS-AORZ-CL2URE-20221110144837

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 09/12/2022
Date Signed: 09/12/2022 02:34:22 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/13/2021 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210713094401

FACILITY NAME:	CITRUS HILLS ASSISTED LIVING		FACILITY NUMBER:	306005603
ADMINISTRATOR:	TANJA OLANO		FACILITY TYPE:	740
ADDRESS:	142 S PROSPECT ST		TELEPHONE:	(714) 639-3590
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	95	CENSUS: 51	DATE:	09/12/2022
		UNANNOUNCED	TIME BEGAN:	12:11 PM
MET WITH:	Itzayana Barba, Health and Wellness Director		TIME COMPLETED:	12:44 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Facility has rodents

INVESTIGATION FINDINGS:

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

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz made a subsequent visit to address allegation listed above after conducting Annual inspection. LPA Quiroz was COVID-19 screened and granted entry into the facility. LPA Quiroz met with (HWD) Itzayana Barba and Ryan Mims, Maintenance Director and discussed the purpose of today's visit.
On today's date, On or about 9:58am, LPA Quiroz along with (HWD) Itzayana Barba conducted an inspection tour of physical plant, toured residents apartments, interior and exterior common areas. LPA Quiroz conducted interviewees with interviewees and reviewed documents but not limited to Pest Control invoice dated 7/22/2022 and work order service point inspection details dated 8/31/2022.
On or about 12:20pm, LPA Quiroz along with (HWD) Barba inspected the exterior of facility premises. It was alleged that "Facility has rodents." LPA Quiroz did not observe any insects or rodents during today's facility inspection visit. LPA Quiroz interviewed staff and residents who deny ever seeing any insects or rodents.
The Service Point Inspection details dated 8/31/2022 at 9:45am and 9:46am report indicate no activity of rodents in exterior and interior of premises. CONTINUED ON NEXT PAGE...

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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

Control Number 22-AS-20210713094401

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CITRUS HILLS ASSISTED LIVING	FACILITY NUMBER: 306005603
	VISIT DATE: 09/12/2022

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

Pest control services the facility monthly with no reports of insects or rodents, therefore the allegation of "facility has rodents" was UNFOUNDED
Based on the preponderance of evidence, the allegation "Facility has rodents" is deemed UNFOUNDED. This agency has investigated the complaint alleging "Facility has rodents," and have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
An exit interview was conducted with Health and Wellness Director Itzayana Barba, and a copy of this report was provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2