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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880924
Report Date: 12/03/2024
Date Signed: 12/03/2024 03:47:40 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
04/29/2024 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 18-AS-20240429160126
FACILITY NAME:CITRUS PLACEFACILITY NUMBER:
331880924
ADMINISTRATOR:VICKY TORRESFACILITY TYPE:
740
ADDRESS:7898 CALIFORNIA AVENUETELEPHONE:
(951) 687-2241
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:140CENSUS: 111DATE:
12/03/2024
UNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Vicky TorresTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff are not providing adequate supervision to residents
Staff left resident on the floor for an extended period of time
Staff does not administer resident's medications as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kimberly Lyman and Joseph Alejandre conducted an unannounced complaint visit to deliver findings on the above allegations. LPAs were greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPAs toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as incident reports. Regarding the allegations that staff are not providing adequate supervision to residents, staff does not administer resident's medications as prescribed and staff left resident on the floor for an extended period of time, the investigation revealed the following: Facility schedule indicates four caregivers and a med tech for 1st and 2nd shifts and two caregivers/ one med tech for the NOC shift. Nine out of nine staff state scheduling is adequate and staff are able to provide resident care including toileting, showering and assistance with eating. LPA observed residents being assisted with meals. Resident 1 (R1) had one witnessed fall and four unwitnessed falls between 04/11/2024 and 05/01/2024. Resident was assessed and sent out for observation on four instances.
CONTINUED ON LIC 9099C DATED 12/03/2024
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
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 4
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
04/29/2024 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 18-AS-20240429160126

FACILITY NAME:CITRUS PLACEFACILITY NUMBER:
331880924
ADMINISTRATOR:VICKY TORRESFACILITY TYPE:
740
ADDRESS:7898 CALIFORNIA AVENUETELEPHONE:
(951) 687-2241
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:CENSUS: 111DATE:
12/03/2024
UNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Vicky TorresTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Staff engage in physical and verbal altercations between other staff in the presence of residents
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kimberly Lyman and Joseph Alejandre conducted an unannounced complaint visit to deliver findings on the above allegations. LPAs were greeted and granted entry into the facility and explained the reason for the visit.
During the visit, LPAs toured the facility and interviewed staff. Regarding the allegation that staff engage in physical and verbal altercations between other staff in the presence of residents, the investigation revealed the following: On 03/09/2024, Staff 1 (S1) and S2 got into a verbal/ physical altercation in the memory care unit and on 04/04/2024, S3 and S4 got into a verbal/ physical altercation. Both instances were in an area where residents would be witness to the incidents. Two staff involved were given write-ups from the facility. Based on records reviewed and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations,(Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted with facility representative and a copy of this report was provided as well as appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20240429160126
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CITRUS PLACE
FACILITY NUMBER: 331880924
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2024
Section Cited
CCR
87468.1(a)
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Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This req is not being met as evidenced by:
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Licensee to conduct an in-service on personal rights and forward proof to LPA by POC due date.
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Based on interviews conducted, Licensee failed to ensure residents were afforded dignity. Facility staff had two different altercations with themselves. This poses a potential health and safety risk to residents in care.
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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: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 18-AS-20240429160126
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CITRUS PLACE
FACILITY NUMBER: 331880924
VISIT DATE: 12/03/2024
NARRATIVE
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Narrative charting documented care plan meeting on 05/02/2022 to discuss fall prevention for resident. Family was to provide a private caregiver and hospice was providing an LVN to stay with resident at night as resident liked to get up and walk. Resident was put on extra safety checks as well per facility documentation. Nine out of nine staff deny residents being neglected and staff state R1 was always wanting to get up and walk. LPA reviewed medication administration records for six residents. Per documentation, all six received medications on 04/07/2024 and any missed medications in April 2024 were documented in the notes. Based on interviews conducted and records reviewed, LPA is unable to corroborate the allegations. Therefore the allegations are deemed UNSUBSTANTIATED meaning although the allegations 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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4