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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426759
Report Date: 04/20/2026
Date Signed: 04/20/2026 01:09:08 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
09/12/2024 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20240912155637
FACILITY NAME:CITRUS GARDENSFACILITY NUMBER:
336426759
ADMINISTRATOR:TRACY LANGENDOENFACILITY TYPE:
740
ADDRESS:25911 STANFORD STTELEPHONE:
(951) 925-7107
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:64CENSUS: 59DATE:
04/20/2026
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Liliana MorenoTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not prevent resident from causing injuries to another resident in care.
INVESTIGATION FINDINGS:
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On April 20, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Antonine Richard, conducted an unannounced complaint visit. The LPA Richard met with the Executive Director, Valerie Garcia, and the Administrator (A1), Liliana Moreno, and explained the purpose of the visit.

The investigation consisted of collecting records and touring the facility. On April 16, 2026, the Department obtained various documents, including the Personnel Report LIC 500 (dated 04/16/26) and the Resident Roster (dated 04/16/26). The Department reviewed and collected the following documents for residents R1 and R2: the residents' Admission Agreements, the physician's report, the Medical Assessment, the Weekly Scheduled Shower, the facility's menu, the Unusual Incident Report, and the facility notes. The Department also interviewed the Administrator (A1), the Executive Director (ED), four staff members (S1-S4), and six residents (R1-R6). The Department was unable to interview residents R1 and R2 because they no longer live at the facility.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
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 18-AS-20240912155637
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 GARDENS
FACILITY NUMBER: 336426759
VISIT DATE: 04/20/2026
NARRATIVE
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Allegation #1: Staff did not prevent resident from causing injuries to another resident in care.

The complaint alleged that the resident was physically assaulted by another resident and sustained injuries to the resident's eyes. On April 16, 2026, the department interviewed the Executive Director (ED) and the Administrator (A1), both of whom stated that they try to have more staff around residents who are aggressive toward other residents. The Administrator noted that the caregivers are aware of which residents require more supervision and who are likely to act aggressively. Additionally, four staff members (S1-S4) were interviewed, all of whom denied the allegation. They also stated that they are very alert and proactive around residents to prevent any residents from causing injuries to others.

The department then interviewed six residents (R3-R8). 6 out of the six residents denied ever being hurt by other residents. However, the department was unable to interview R1 and R2 because they no longer reside at the facility.

On April 16, 2026, the department reviewed the facility's notes dated 09/06/24 through 09/13/24, which documented that the facility assigned a one-on-one caregiver to R1 due to aggressive behavior and altercations with others. On 09/11/24, during the incident, the caregiver intervened and called Medical Emergency Services (MES), which transported residents R1 and R2 to the hospital. R2 was placed on a 51/50 hold. Both were discharged on 09/12/24. The department also reviewed the Unusual Incident Report dated 09/12/24, which was sent to Community Care Licensing and the Ombudsman.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240912155637
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 GARDENS
FACILITY NUMBER: 336426759
VISIT DATE: 04/20/2026
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was provided to Administrator Liliana Moreno.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3