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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000789
Report Date: 05/23/2024
Date Signed: 05/23/2024 12:56:33 PM

Document Has Been Signed on 05/23/2024 12:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HIGHLAND VIEW CARE HOMEFACILITY NUMBER:
045000789
ADMINISTRATOR/
DIRECTOR:
SERRANO,NORA CHAVEZFACILITY TYPE:
735
ADDRESS:62 HIGHLANDS BLVD.TELEPHONE:
(530) 533-3079
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY: 6CENSUS: 3DATE:
05/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Michael Ting - care staffTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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05/23/2024 12:00 PM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with care staff Michael Ting. House manager Virginia Moebs was contacted by telephone call and approved Mr. Ting to sign the report. Today’s visit is regarding an incident that occurred on 05/13/2024 and was reported to licensing on 05/14/2024.

It was reported that on 05/13/2024 Client 1 (C1) arrived back at the facility from his day program. Staff assisted C1 walking from the bus into the facility and observed that C1 was having a hard time walking. At approximately 4:30pm, staff noticed that C1 was having a hard time moving around, standing, and C1’s face was red. Staff asked how C1 was feeling and he kept saying "I'm fine, I'm okay". Staff called 911/Emergency Services and transported C1 to Oroville Hospital Emergency Room.

On 05/14/2024 staff went to visit C1 at the hospital and to talk to the doctor/nurse. The attending nurse informed staff that C1 was being treated for "general weakness infection" and he had been administered an antibiotic. Hospital staff performed an ultrasound on both of C1's legs. At 11:45am, staff spoke with the attending doctor to ask what C1’s diagnosis was. Doctor said C1 was being treated for general weakness post fall, bilateral knee pain. Staff was confused by the diagnosis because C1 had not been observed to have fallen at any time the night before.

During the course of the investigation, it was learned that C1 was diagnosed with UTI and treated at the hospital. C1 was discharged on 05/16/2024 and is now home. LPA interviewed C1 who stated they had not fallen. C1 has home health following for physical, occupational, and speech therapy. LPA also interviewed house manager via telephone call.

No deficiencies were cited as a result of today’s visit. Exit interview conducted and a copy of the report was provided to Nora Serrano.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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