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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 12/24/2024
Date Signed: 12/24/2024 12:15:52 PM

Substantiated


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
12/23/2024 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20241223142646
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: 83DATE:
12/24/2024
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Charles Marinko - Administrator TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility does not have hot water
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannouced visit to conduct a 10 day visit. LPA was greeted and granted entry into the facility by Receptionist Cindy Mora and explained the reason for the visit. Administrator Charles Marinko arrived shortly after.

The Department received a complaint that alleged the facility does not have hot water. During the visit LPA Mendivil toured the faciltiy with Maintenance Director Jesse Chrisman. LPA observed water tanks on the roof the facility. In addtion, LPA Mendivil interviewed staff and residents. Regarding the allegation that the facility does not have hot water, the investigation revealved the following:

LPA Mendivil tested 2 out of 4 Spa Restrooms which contains 2 sinks and a shower, the other 2 spa bathrooms were occupied. Spa Bathroom on the first floor by Room 106 tested at 125 degrees for both sinks and 106 for the shower. Spa bathroom located on the second floor by room 217 the sinks tested at 119 degrees and 110 degrees with the shower testing at 100 degrees.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
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
Control Number 22-AS-20241223142646
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: 12/24/2024
NARRATIVE
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LPA Mendivil interviewed 4 residents, 4 out of 4 residents stated the water temperature is inconsistent as of 12/24/2024, but over the weekend on 12/21/2024 it was reported they did not have hot water in the restrooms. Based on interviews with 5 out of 5 staff indicated they were aware there was inconsistency with the water temperature. Administrator Charles Marinko stated they reached out to multiple plumbers and was able to reach a technician which specializes in the type of water heater the facility has. Administrator Charles stated the technician is scheduled to be at the facility today 12/24/2024.

Administrator Charles stated they had a back up plan to take residents to a sister community if the shower issue persisted.

LPA Mendivil observed the kitchen sink temperatures to be at 68 degrees. LPA Mendivil interviewed Dining Director Guillermo Sotelo which stated they have the ability to boil water and the dishwasher has its own water heater and therefore operational.

Therefore based on the preponderance of evidence through observations and interviews the allegation facility does not have hot water is SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred.

The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8.

An exit interview was conducted and a copy of this report and appeal rights was provided to the facility representative.



SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20241223142646
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2024
Section Cited
CCR
87303(a)
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(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.
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Administrator indicated they have a technician who is going to maintenance the water heaters. Administrator to send proof of kitchen sink temperature by POC due date of 12/30/2024.
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This requirement is not met as evidence by the kitchen sink does not have hot water. The facility is still able to boil water for cooking, this poses a potential health and safety 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: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3