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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 02/11/2025
Date Signed: 02/11/2025 03:16:14 PM

Substantiated


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
11/14/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241114102450
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: 88DATE:
02/11/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Angelica Penate, Health and Wellness Director TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Licensee used full bed rails for non-hospice resident.

Staff did not ensure resident was provided with adequate bed linens.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegations listed above. LPA was greeted and granted entry by facility front desk staff after introducing himself and stating the purpose of the visit.

An initial complaint investigation visit took place on November 20, 2024. LPA accompanied by the facility's Health and Wellness Director conducted a tour of the facility's two levels and reviewed a total of 10 units throughout the physical plant. One staff and three resident interviews were conducted. Records for five residents were requested and reviewed in addition to the facility's census, staff roster and facility shower schedule.

During the present visit, LPA reviewed the current facility census. The physical plant was toured again and an additional five resident interviews were conducted. Five resident records requested and reviewed.
CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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 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
11/14/2024 and conducted by Evaluator Kevin Saborit-Guasch
COMPLAINT CONTROL NUMBER: 22-AS-20241114102450

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: 88DATE:
02/11/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Angelica Penate, Health and Wellness Director TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not assist residents with mobility needs in a timely manner.

Staff did not ensure resident’s showering needs were met.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegations listed above. LPA was greeted and granted entry by facility front desk staff after introducing himself and stating the purpose of the visit.

An initial complaint investigation visit took place on November 20, 2024. LPA accompanied by the facility's Health and Wellness Director conducted a tour of the facility's two levels and reviewed a total of 10 units throughout the physical plant. One staff and three resident interviews were conducted. Records for five residents were requested and reviewed in addition to the facility's census, staff roster and facility shower schedule.

During the present visit, LPA reviewed the current facility census. The physical plant was toured again and an additional five resident interviews were conducted. Five resident records requested and reviewed.
CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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-20241114102450
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: 02/11/2025
NARRATIVE
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CONTINUED FROM LIC9099-A
Regarding the allegation that Staff did not assist residents with mobility needs in a timely manner, the following has been concluded: Based on eight interviews conducted with facility residents along with tours of the physical plant, all residents with limited mobility met or observed were fully able to access the facility's call system from their bed. A majority of residents interviewed either stated no concerns with facility staff response time or stated that they were satisfied with response times.

Regarding the allegation that Staff did not ensure resident’s showering needs were met, the following has been concluded: During a total of eight resident interviews conducted, a majority of residents stated that they received adequate assistance for their personal toileting care and expressed no complaints with the frequency of the showers provided by facility staff.

As a result, both allegations are found to be Unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20241114102450
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: 02/11/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Licensee used full bed rails for non-hospice resident, the following has been concluded: During the initial complaint investigation visit conducted on November 20, 2024, licensing staff observed resident R1 was placed in a hospital bed equipped with half-rails that were positioned lower than the head of the bed. Once the upper part of the bed frame became elevated, it was observed that the half-rails functioned the way full-length rails would. Based on interviews conducted and files reviewed, R1 was confirmed to not be received hospice care at the time of the visit.

Regarding the allegation that Staff did not ensure resident was provided with adequate bed linens, the following has been concluded: Based on observation made during the initial complaint investigation visit, R1 had mobility issues related to a surgical intervention and was placed in a hospital bed. During the visit, linen were observed to be crumpled up underneath the resident, leaving the resident to lay on a bare mattress.

As a result of both observations, the allegations are found to be Substantiated, meaning that the preponderance of evidence has been met. Deficiencies cited on an attached form LIC9099-D.

An exit interview was conducted with facility staff and a copy of this report along with appeal rights were provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20241114102450
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: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2025
Section Cited
CCR
87608(a)(5)(B)
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3
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7
Per CCR 87606(a)(5)(B) on Postural Supports: "Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails." This requirement is not met as evidenced by:
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During the follow-up investigation, it was confirmed that R1 was no longer a facility resident. Full rails orders for current residents were reviewed and confirmed to be valid. Deficiency cleared.
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Based on observation and records reviewed, resident R1 was placed in a bed equipped with half rails functioning as full rails despite not receiving hospice care at the time. This constitutes a potential risk to the health, safety and personal rights of individuals in care.
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Type B
02/12/2025
Section Cited
CCR
87307(a)(3)(C)
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Per CCR Personal Accomodations and Services: "(...) the licensee shall assure provision of: Clean linen(..) The quantity shall be sufficient (...) to ensure that clean linen is in use by residents at all times."
This requirement is not met as evidenced by:
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During the follow-up investigation, all rooms reviewed were adequately equipped with linen. Deficiency cleared.
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Based on observation and records reviewed, resident R1 was positioned on a bare mattress during the initial investigation visit. This constitutes a potential risk to the health, safety and personal rights of individuals in care.
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9
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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: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5