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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880924
Report Date: 11/21/2024
Date Signed: 11/21/2024 03:41:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
04/15/2024 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 18-AS-20240415154217
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: 117DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Vicky TorresTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent resident from pushing another resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kimberly Lyman and Joseph Alejandre conducted an unannounced complaint visit to continue the investigation into the above allegation. LPAs were greeted and granted entry into the facility and explained the reason for the visit.
During the investigation, the department toured the facility and interviewed staff and residents as well as reviewed and obtained pertinent documentation such as physician reports. Regarding the allegation that staff did not prevent resident from pushing another resident, the investigation revealed the following: On 04/13/2024, Resident 1 (R1) was being escorted back to the resident's room when R2 entered the room and became agitated. R2 pushed R1 and R1 fell and hit the head. R1 was transported to the hospital via 911 and returned with no new findings. Both residents are diagnosed with Dementia and denied the altercation occurred. Staff interviewed confirmed being present when the altercation occurred. Based on interviews conducted and records reviewed, LPA is unable to corroborate the allegation. Therefore the allegation is deemed UNSUBSTANTIATED meaning although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violation occurred.
An exit interview was conducted and a copy of this report was provided to Administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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