342700077-12-21-2020-27-AS-KHOS-BWXLFB-20210104074253

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700077
Report Date: 12/21/2020
Date Signed: 12/21/2020 05:27:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/13/2020 and conducted by Evaluator Bethany Huusfeldt

COMPLAINT CONTROL NUMBER: 27-AS-20200713131144

FACILITY NAME:	COURTE AT CITRUS HEIGHTS, THE		FACILITY NUMBER:	342700077
ADMINISTRATOR:	BAUTISTA-COLMENARES, DONNA		FACILITY TYPE:	740
ADDRESS:	6825 SUNRISE BLVD		TELEPHONE:	(916) 721-0644
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	48	CENSUS: 38	DATE:	12/21/2020
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Kayla Davis, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility staff did not keep emergency exits clear of obstruction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Huusfeldt met with Kayla Davis. Today's visit was conducted over the phone due to COVID precautions.

LPA investigated the allegation of “Facility staff did not keep emergency exits clear of obstruction”. During complaint investigation LPA interviewed staff, conducted facility inspection, and reviewed documentation. LPA interviewed 4 staff in which all stated they have observed chairs or tables in front of the emergency exits. Additionally staff stated there has been an issue with insufficient staffing throughout the summer of 2020. LPA observed pictures of chairs and tables in front of emergency exits. LPA conducted a facility tour on 07/13/20 and did not observe emergency exits blocked.

Continuation on 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20200713131144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: COURTE AT CITRUS HEIGHTS, THE	FACILITY NUMBER: 342700077
	VISIT DATE: 12/21/2020

NARRATIVE

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LPA reviewed Facility plan of operation, in which it states, “The community will not substitute delayed egress devices for trained staff in sufficient numbers to meet the care and supervision needs of all residents and to escort residents who leave its premises."

Due to the information gathered, LPA finds allegation to be Substantiated. As a result of this investigation, LPA finds allegations to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met: Refer to the 9099-D.

Refer to 9099-D for review of deficiency and POC. Copy of report and appeal rights were emailed to Administrator

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20200713131144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: COURTE AT CITRUS HEIGHTS, THE	FACILITY NUMBER: 342700077
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/31/2020 Section Cited CCR 87705(k)(8)	1 2 3 4 5 6 7	87705 Care of Persons with dementia (k) The following initial and continuing requirements must be met for the licensee to utilize delayed egres devices on exterior doors or perimeter fence gates:(8) Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents and to escort residents who leave the facility.	1 2 3 4 5 6 7	Administrator agrees to conduct a training with all care staff in regards to the proper use of the delayed egress. Training subject matter and staff sign in sheet to be submitted to LPA by 12/31/20.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews, facility did not keep emergency exits clear which poses an immediate health & safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2020

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020

LIC9099 (FAS) - (06/04)

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