<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005603
Report Date: 12/24/2024
Date Signed: 12/24/2024 12:22:01 PM

Document Has Been Signed on 12/24/2024 12:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
306005603
ADMINISTRATOR/
DIRECTOR:		ITZAYANA BARBA AGUIRREFACILITY TYPE:
740
ADDRESS:142 S PROSPECT STTELEPHONE:
(714) 639-3590
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 95CENSUS: 83DATE:
12/24/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:46 AM
MET WITH:Administrator Charles Marinko TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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
On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit in conjunction with complaint visit for complaint control 22-AS-20241223142646. LPA Mendivil toured the facility with Maintenance Director Jesse Chrisman and observed 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.

Per interview with Administrator Charles Marinko a technician is coming out to the facility on 12/24/2024. Based on interviews with 4 out of 4 residents stated that the hot water is inconsistent and can "flash" to cold and then back to hot. LPA Mendivil tested hot water in kitchen sink which read at 68 degrees.

Administrator Charles stated they will provide a sign to advise residents of the water temperature in sinks is over 125 degrees.

Therefore based on observations deficiencies are being cited. An exit interview was conducted and a copy of this report was provided.
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.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/24/2024 12:22 PM - It Cannot Be Edited


Created By: Andrea Mendivil On 12/24/2024 at 11:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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(e)(2)

1
2
3
4
5
6
7
(e) Water supplies and plumbing fixtures shall be maintained as follows:(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature...
1
2
3
4
5
6
7
Administrator has placed signs at the sinks that are over 125 degrees in addition a technician is scheduled to maintenance water heater on 12/24/2024. Administrator to provide proof to LPA by POC due date.
8
9
10
11
12
13
14
... attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidence by water is not maintained at regulation temp. This poses a potential risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S 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


LIC809 (FAS) - (06/04)
Page: 2 of 2