306005603-1-29-2025-22-AS-AJLO-DDFR7W-20250131114702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:56:36 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
11/01/2024 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241101164055

FACILITY NAME:	CITRUS HILLS ASSISTED LIVING		FACILITY NUMBER:	306005603
ADMINISTRATOR:	ITZAYANA BARBA AGUIRRE		FACILITY TYPE:	740
ADDRESS:	142 S PROSPECT ST		TELEPHONE:	(714) 639-3590
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	95	CENSUS: 86	DATE:	01/29/2025
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Clinical Director-Angelica Perez Penate		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff left resident in a soiled diaper for a long period of time.
Staff did not replace resident's call button.
Staff did not serve resident meals.
Facility staff did not give the resident's medication as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on November 01, 2024. LPA was greeted and granted entry into the facility and met with Receptionist Cindy Mora. LPA explained the reason for the visit. Clinical Director (CD) Angelica Perez Penate arrived shortly after.

This Department has investigated the complaint alleging staff left resident in a soiled diaper for a long period of time. Regarding the allegation the following was revealed: During the course of the investigation LPA reviewed documents including the Citrus Hills Assisted Living Service Plan dated October 08, 2024 for Resident 1 (R1). Per Service Plan under Toileting for R1 it states incontinent of bladder requires assist from staff and incontinent of bowel requires assist from staff. Per Service Plan care staff to provide brief changes every two hours and as needed due to incontinence of bowel and bladder. During the course of the interviews with Residents, R1 reported that staff do not always change their diaper as needed and stated that sometimes they have to wait over one hour before staff can change their diaper.
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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-20241101164055

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: 01/29/2025

NARRATIVE

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Per R2 staff change his diaper as needed and reported that he has never been left in a soiled diaper. During the course of the interviews with staff, Staff 1 (S1) reported that staff usually do rounds every hour and stated that no other residents have complained about being left in a soiled diaper for a long period of time. Per S2 she changes R1’s diaper as needed and stated that she checks on R1 at least every two hours.

Regarding the allegation that staff did not replace resident’s call button, the following was revealed: During the initial visit on November 07, 2024, and subsequent visit on January 29, 2025, LPA observed that R1’s call button was replaced. During the course of the interviews with Residents, R1 reported that their call button was broken the whole night of October 31, 2024, and stated that the call button was broken until the evening the next day. Per R2 his call button works good and stated that it gets answered within 10-20 minutes. Per R3 the call button works properly. During the course of the interviews with staff, S1 reported that the facility has extra call buttons and stated that it can replaced the same day.

Regarding the allegation that staff did not serve resident meals, the following was revealed: During the investigation LPA reviewed documents including the Citrus Hills Assisted Living Service Plan dated October 08, 2024 for R1. Per Service Plan under Nutrition/Eating it states Resident will be offered choices in menu, with escorts and meal assistance as requested or needed. Per Service Plan it states provide meals three times daily, meal trays per resident request and verbal reminders for meals. During the course of the interviews with Residents, R2 reported that he gets three meals per day. Per R4 staff bring her three meals to her bedroom per day and stated that she always gets her breakfast, lunch and dinner. During the course of the interviews with staff, S2 reported that when a resident is sick, the kitchen staff bring the meals to the residents' bedroom.

Regarding the allegation that facility staff did not give the resident's medication as prescribed, the following was revealed: LPA reviewed documents including the Physician Report (LIC602A) dated May 10, 2023, for R1. Per Physician Report R1 is not able to administer own prescription medications. During the investigation LPA reviewed documents including the Medication Administration Record (MAR) dated October 01, 2024, to November 07, 2024, and MAR dated January 01, 2025, to January 31, 2025. Per MAR dated October 01, 2024, to November 07, 2024, R1 was given their medication as prescribed except on October 24 and 25.

CONTINUED ON LIC9099-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241101164055

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: 01/29/2025

NARRATIVE

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Per MAR on October 24 and 25 the medications Mirtazapine Oral Tablet 15 MG and Quetiapine Fumarate Oral Tablet 200 MG were not administered. Per MAR on October 24 and 25 the chart code was entered as 7 which stands for other/see Nurse note. Per Nurse note on October 24 and 25 it states that the medication needs to be ordered. Per MAR dated January 01, 2025, to January 31, 2025, R1 was given their medications as prescribed. During the course of the interviews with Residents, R2 reported that staff administer his medications and reported that he gets his medications timely after every meal. During the course of the interviews with staff, S1 reported that residents get their medications as prescribed and stated that R1 is getting their medications as prescribed.

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

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

LPA 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: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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