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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002886
Report Date: 08/13/2025
Date Signed: 08/13/2025 01:02:00 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2025 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 59-AS-20250605143636
FACILITY NAME:CITRUS CREST CARE HOME 1FACILITY NUMBER:
345002886
ADMINISTRATOR:CHAVEZ, ANGELICAFACILITY TYPE:
740
ADDRESS:6906 HENNING DRIVETELEPHONE:
(916) 728-1338
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 4DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Staff, Pauline MyresTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Illegal eviction.
INVESTIGATION FINDINGS:
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On 08/13/25, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility and met with Staff, Pauline Myres to deliver findings into the allegation listed above. LPA explained the pupose of today's visit. Administrator, Mariam Soumahoro was not avaiable so administrator gave permission to staff via phone, Pauline Myres to conduct today's visit and sign the report.

Allegation- Illegal eviction. Substantiated

The department reviewed records, interviewed witnesses, and administrator to investigate this allegation. Record review indicated that facility issued 30 days Eviction Notice to resident, R1 on 06/04/25 with the reason indicating “needs high level of care”. It was noted that there was no documentation from facility to indicate why facility was not able to meet resident’s care needs with current care plan. Additionally, facility did not send Eviction Letter from 06/04/25 issued to R1 for Departmental review and approval as required. Interviews and record review reflected that R1’s family and/or responsible party moved R1 from the facility on 06/05/25. Based on gathered information, this allegation was found to be Substantiated. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached LIC9099-D page.Exit interview was conducted . A copy of this report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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 4
Control Number 59-AS-20250605143636
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CITRUS CREST CARE HOME 1
FACILITY NUMBER: 345002886
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2025
Section Cited
CCR
87224
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87224-(a)The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5)....(4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted ...this requirement is not met as evidence by;
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Licensee/Administrator shall send a letter of understanding of this regulation and to ensure to follow this regulation for all residents per operational needs. All POC requirements are due by 08/27/25.
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Record review indicated that facility issued 30 day eviction letter to resident, R1 on 06/04/25 but did not conduct reappraisal and did not send this for departmental review for approval before issuing which poses a potential health and safety risks 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: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2025 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 59-AS-20250605143636

FACILITY NAME:CITRUS CREST CARE HOME 1FACILITY NUMBER:
345002886
ADMINISTRATOR:CHAVEZ, ANGELICAFACILITY TYPE:
740
ADDRESS:6906 HENNING DRIVETELEPHONE:
(916) 728-1338
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 4DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Staff, Pauline MyresTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff are not feeding resident.
INVESTIGATION FINDINGS:
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On 08/13/25, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility and met with Staff, Pauline Myres to deliver findings into the allegation listed above. LPA explained the pupose of today's visit. Administrator, Mariam Soumahoro was not avaiable so administrator gave permission to staff via phone, Pauline Myres to conduct today's visit and sign the report.

The department reviewed records, facility’s observations and interviewed witnesses, three staff members and three residents to investigate this allegation.


**Report continued on 9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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 59-AS-20250605143636
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CITRUS CREST CARE HOME 1
FACILITY NUMBER: 345002886
VISIT DATE: 08/13/2025
NARRATIVE
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***Report continued from 9099-A....

Allegation- Staff are not feeding resident. Unsubstantiated

The department reviewed records, facility’s observations and interviewed witnesses, three staff members and three residents to investigate this allegation. Staff interviews indicated that facility has adequate food supplies and resident’s dietary needs were met per resident’s care plans and there were no issues identified. Resident interviews indicated that facility was providing meal services to them per their dietary needs and preferences and there were no complaints. Furthermore, record review indicated that resident, R1 moved into the facility in August 2024 and per LIC602, R1 weight was 130 lbs. R1’s weight was noted to be 133 lbs during a medical visit on 06/05/25. Medical records indicated there were no issues regarding R1s weight loss or dietary needs. During department visits, it was observed that facility has adequate food supplies per Regulations. Based on gathered information, this allegation was found to be Unsubstantiated.

Due to the observations and interviews, LPA finds this allegation to be UNSUBSTANTIATED - meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.



Exit interview conducted and copy of this report was provided.



SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4