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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880924
Report Date: 11/12/2021
Date Signed: 11/12/2021 10:51:40 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2021 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210818134318
FACILITY NAME:CITRUS PLACEFACILITY NUMBER:
331880924
ADMINISTRATOR:SPENCER, LORIFACILITY TYPE:
740
ADDRESS:7898 CALIFORNIA AVENUETELEPHONE:
(951) 687-2241
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:140CENSUS: 110DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lori Spencer, Executive DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Lack of care resulted in resident's health decline
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, made an unannounced visit to the facility to deliver the findings of the investigation into the above allegation. The LPA was met by Receptionist, Donna Rebuck, and later met with Executive Director (ED), Lori Spencer. Spencer was informed of the purpose of the visit.

Regarding the allegation, "Lack of care resulted in resident's health decline," it was alleged the facility did not provide quality care to Resident One (R1) resulting in a decline in their health independence, such as R1's body becoming unequal to the rest of their body, their head tilting down to where their ear is near their shoulder, R1 having an inability to look ahead, a loss of balance, present use of a wheeled walker and frequent hospitalizations. The LPA initiated the investigation on August 24, 2021; staff/resident interviews were conducted, records reviewed, and copies of pertinent documentation obtained. ED Spencer was interviewed and denied the allegation; she reported R1 has only had one (1) recent hospitalization. R1 was interviewed and denied staff are not meeting their health needs (R1 is diagnosed with a health condition which does impact the reliability of their statement). On one occasion, August 24, 2021, the LPA observed R1 to utilize a wheeled
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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 2
Control Number 18-AS-20210818134318
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CITRUS PLACE
FACILITY NUMBER: 331880924
VISIT DATE: 11/12/2021
NARRATIVE
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walker when walking, however, on another occasion, October 22, 2021, the resident did not utilize the device when walking. A review of records produced documentation of Physical Therapy provided to R1 from May to June 2021 and for several days in July 2021. One (1) Unusual Incident Report (UIR) was observed on file for R1 indicating the resident was hospitalized on June 15, 2021. A Physical Therapy Plan of Care, dated July 19, 2021, revealed R1 was receiving Physical Therapy to address impairments and limitations in function related to R1's hospitalization. Therefore, based on interviews and records review, this allegation is deemed UNFOUNDED at this time. A finding that the complaint is unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis. No citation will be issued at this time.

This report was reviewed with Spencer and a copy provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2