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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 10/03/2024
Date Signed: 10/03/2024 03:50:16 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/25/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240925145424
FACILITY NAME:CITRUS HILLS ASSISTED LIVINGFACILITY NUMBER:
306005603
ADMINISTRATOR:ITZAYANA BARBA AGUIRREFACILITY TYPE:
740
ADDRESS:142 S PROSPECT STTELEPHONE:
(714) 639-3590
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:95CENSUS: 82DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Cindy Mora-ReceptionistTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Facility staff are not providing a clean and sanitary environment for residents in care.
Facility staff are not ensuring that resident grab bars are safe for residents in care.
Facility staff are not keeping the facility free of insects.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Samer Haddadin conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegations and to deliver the findings of the investigation. LPAs were greeted and granted entry into the facility and met with Receptionist Cindy Mora. LPAs explained the reason for the visit. Administrator (AD) Itzayana Barba Aguirre was notified by staff via telephone.

This agency has investigated the complaint alleging that facility staff are not providing a clean and sanitary environment for residents in care, facility staff are not ensuring that resident grab bars are safe for residents in care and facility staff are not keeping the facility free of insects. Regarding the allegations, the following was revealed: During the course of the interviews six of eight individuals interviewed denied that staff are not providing a clean and sanitary environment for residents in care. During the course of the interviews with residents, Resident 1 (R1) reported that it could be better and stated that staff clean their bedroom and
CONTINUED LIC9009-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/25/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240925145424

FACILITY NAME:CITRUS HILLS ASSISTED LIVINGFACILITY NUMBER:
306005603
ADMINISTRATOR:ITZAYANA BARBA AGUIRREFACILITY TYPE:
740
ADDRESS:142 S PROSPECT STTELEPHONE:
(714) 639-3590
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:95CENSUS: 82DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Cindy Mora-ReceptionistTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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9
Facility staff are not ensuring that resident screen doors are in good repair
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Samer Haddadin conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPAs were greeted and granted entry into the facility and met with Caregiver Lolita Orcullo. LPAs explained the reason for the visit. Administrator (AD) Charles Pham arrived shortly after.

This agency has investigated the complaint alleging that facility staff are not ensuring that resident screen doors are in good repair. Regarding the allegation, the following was revealed: Three of eight individuals interviewed confirmed the allegation. During the initial visit on October 03, 2024 LPAs toured the facility and observed that four out of thirteen screen doors facing the first floor patio do not slide at all and/or are in disrepair. On the second floor patio LPAs observed that one of two screen door do not slide properly and/or is in disrepair. During the course of the interviews with residents, Resident 1 (R1) reported that their screen door does not slide and stated that it was already reported to the maintenance director.
CONTINUED ON LIC9009-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20240925145424
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CITRUS HILLS ASSISTED LIVING
FACILITY NUMBER: 306005603
VISIT DATE: 10/03/2024
NARRATIVE
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During the course of the interviews with staff, Staff 1 (S1) reported that some screen doors are broken. Per S1 a couple of resident have complained and stated that the maintenance director is fixing the issue.

Based on observations and the interviews which were conducted, the preponderance of evidence standard has been met, therefore the following allegation: Facility staff are not ensuring that resident screen doors are in good repair is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.

An exit interview was conducted with facility representative and a copy of this report along with the Appeal Rights were provided at the time of this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20240925145424
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CITRUS HILLS ASSISTED LIVING
FACILITY NUMBER: 306005603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2024
Section Cited
CCR
87303(a)
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Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by:
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Licensee to repair all screen doors and email POC proof to LPA by POC date.
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Based on observations and interviews with the resident some screen doors do not open/slide and/or are in disrepair. This poses a potential health, safety or personal rights risk to persons in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20240925145424
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CITRUS HILLS ASSISTED LIVING
FACILITY NUMBER: 306005603
VISIT DATE: 10/03/2024
NARRATIVE
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bedding daily. Per R1 the facility is pretty much clean all the time and reported that the new cleaning lady cleaned their restroom and it looks amazing. During the initial visit LPAs observed as housekeeping staff were cleaning bedrooms on the first and second floor.

Regarding the allegation that facility staff are not ensuring that resident grab bars are safe for residents in care, the following was revealed: Six of eight individuals interviewed denied the allegation. During the initial visit LPAs toured random restrooms throughout the facility and observed that grab bars were in good repair. During the course of the interviews R1 reported that they use the grab bars all the time and stated that the grab bars are in good condition. Per R2 the grab bars are fine. During the course of the interviews with staff, Staff 1 (S1) reported that the grab bars are safe and stable for the residents' use.

Regarding the allegation that facility staff are not keeping the facility free of insects, the following was revealed: Four of eight individuals interviewed denied the allegation. During the course of the interviews R2 stated that she has not seen insects or bugs. Per R3 he has not seen insects or bugs. During the course of the investigation LPAs reviewed documents including the Pestprotection Pest Control dated August 27, 2024. Per Pest Control report the following was done apply crawling insect prevention to the exterior perimeter of the building, treat the interior of building common areas, restroom areas, storage areas, spa rooms and inspect 7 units at the time of service.

Based on the information gathered during the investigation and review of documents obtained, LPAs are unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, this allegations are deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.


LPAs conducted an exit interview with facility representative, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5