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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005603
Report Date: 06/05/2026
Date Signed: 06/05/2026 03:08:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/19/2026 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260319124734
FACILITY NAME:CITRUS HILLS ASSISTED LIVINGFACILITY NUMBER:
306005603
ADMINISTRATOR:ITZAYANA BARBA AGUIRREFACILITY TYPE:
740
ADDRESS:142 S PROSPECT STTELEPHONE:
(714) 639-3590
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:95CENSUS: 92DATE:
06/05/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Mansi Modi-Wellness CoordinatorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Resident's needs were not met
Resident developed sores due to lack of care and supervision
Staff were not responsive to resident's authorized representative
Residents were not accorded a safe environment
Staff did not safeguard resident's personal belongings
Staff did not ensure laundry washer and dryer were in good repair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on March 19, 2026. LPA was greeted and granted entry into the facility and met with Wellness Coordinator (WC) Mansi Modi. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that resident's needs were not met. Regarding the allegation the following was revealed: During the investigation LPA reviewed the Physician Report (LIC602A) dated October 17, 2025, for Resident 1 (R1). Per Physician report, R1 is able to communicate needs, able to feed self and is not able to administer own oxygen. LPA reviewed the Mission Hospice sign in log dated December 17, 2025, through March 11, 2026, for R1. Per sign in log, on average the resident was given a bath every other day. LPA reviewed the Service Plan Report dated March 19, 2026, for R1. Per Service Plan Report, under Oxygen interventions it states reminders to keep nasal cannula in place.

CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
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 22-AS-20260319124734
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CITRUS HILLS ASSISTED LIVING
FACILITY NUMBER: 306005603
VISIT DATE: 06/05/2026
NARRATIVE
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During the interviews with resident, R2 reported that staff help her with her showers and with washing her clothes. R3 reported that staff are meeting her needs. During the interviews with staff, Staff 1 (S1) through S3 reported that staff are meeting the residents' needs and/or reported that staff assists the residents with their Activities of Daily Living (ADLs) such as meals and oxygen.

Regarding the allegation that resident developed sores due to lack of care and supervision, the following was revealed: During the investigation LPA reviewed the Hospice Plan of Care dated February 10, 2026, for R1. Per Hospice Plan of Care, it states primary diagnosis Non rheumatic Tricuspid (Valve) Insufficiency. Per Hospice medication list, on February 5, 2026, R1 was prescribed Betadine Swabsticks 10 % for Wound Care. Per Hospice medication list, on February 19, 2026, the Wound Care medication was discontinued. During the interviews with residents, R2 and R3 reported that they have not develop sores due to lack of care and supervision. During the interviews with staff, S1-S3 reported being unaware and/or stated that they never noticed sores on R1. During the interviews the Executive Director (ED) reported that R1 did not develop sores due to lack of care and supervision.

Regarding the allegation that staff were not responsive to resident's authorized representative, the following was revealed: During the investigation LPA reviewed the Citrus Hills Assisted Living Admission Agreement dated February 10, 2025, for R1. Per Admission Agreement under Family Visits, it states the community's policy...intends to encourage family involvement with residents and to provide ample opportunity for family participation. During the interviews with residents, R2 reported that management communicates with her sister and stated that she has no issues. During the interviews with staff, S1-S3 reported not being aware. During the interviews the ED reported that management is responsive and communicates with the resident's authorized representative.

Regarding the allegation that residents were not accorded a safe environment, the following was revealed: During the interviews with residents, R2 reported that she feels safe here. Per R3, the residents are being provided a safe environment. During the interviews with staff, S1-S3 reported that the residents are accorded a safe environment and/or reported that staff are always doing rounds throughout their shift. During the interviews the ED stated that management monitors the hallway entrance/exit cameras. ED reported that they do not have an issue with homeless coming into the facility.


CONTINUED ON LIC9099-C...
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260319124734
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CITRUS HILLS ASSISTED LIVING
FACILITY NUMBER: 306005603
VISIT DATE: 06/05/2026
NARRATIVE
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Regarding the allegation that staff did not safeguard resident's personal belongings, the following was revealed: During the investigation LPA reviewed the Service Plan Report for R1. Per Service Plan Report, under laundry tasks it states resident requires assistance with laundry once a week on Fridays in the evening. During the interviews with residents, R2 and R3 reported that staff safeguard their personal belongings and/or stated that staff do an outstanding job. During the interviews with staff, S1 reported that when she washed for R1 that she would place his clean socks and bedding in his closet. S2 and S3 stated that after washing the residents' clothes that staff return the residents' personal belongings back to the resident's closet. Per ED, staff never lose the residents' personal belongings.

Regarding the allegation that staff did not ensure laundry washer and dryer were in good repair, the following was revealed. During the initial visit on March 27, 2026, and subsequent visit on June 5, 2026, LPA tour the facility and observed that the washers and dryers were working properly. During the interviews with residents, R2 reported that the dryer and washer are in good repair. R3 stated that his clothes always get washed. During the interviews with staff, S1-S3 reported that the washer and dryer were replaced recently and stated that they can use the backup washer and dryer. During the interviews the ED reported that the washer and dryer have never been in disrepair and stated that there are three sets.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.
LPA conducted an exit interview with facility representative, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3