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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700012
Report Date: 09/25/2024
Date Signed: 09/25/2024 01:06:39 PM


Document Has Been Signed on 09/25/2024 01:06 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:TWIN RIVERS AT NATOMASFACILITY NUMBER:
342700012
ADMINISTRATOR:GENAYA REESEFACILITY TYPE:
740
ADDRESS:421 SAN JUAN ROADTELEPHONE:
(916) 216-3058
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:48CENSUS: 39DATE:
09/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:18 PM
MET WITH:Sita Vadarevu, Executive DirectorTIME COMPLETED:
01:19 PM
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On September 25, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced for a Case Management visit. LPA met with Sita, executive director, and informed her the reason for the visit.

On August 8, 2024, Sita admitted a resident that came from a skilled nursing facility. That resident came to the facility with medication (narcotics). A second medication was mailed to the facility as well August 7. On August 31, 2024, Sita found medications outside the medication room, which was missing 30 pills out of 60 pills.
Sita conducted an investigation and discovered a staff that had been employed with her for 4 years knew the most about the medication and signed for them when they arrived, but did not log them in. The next day 30 of those pills were missing. Sita terminated the staff's employment due to not following proper procedures and not reporting the incident to her when It happened.

Sita filed a police report with Sacramento County Police. LPA reviewed the report.

No citations were issued.

An exit interview was conducted and a copy of this report was given to Sita.

SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
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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