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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 11/22/2022
Date Signed: 11/22/2022 04:45:06 PM


Document Has Been Signed on 11/22/2022 04:45 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:COURTE AT CITRUS HEIGHTS, THEFACILITY NUMBER:
342700077
ADMINISTRATOR:ARMSTRONG, ANDREAFACILITY TYPE:
740
ADDRESS:6825 SUNRISE BLVDTELEPHONE:
(916) 721-0644
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:48CENSUS: 17DATE:
11/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Kylie Whitaker, Health Services Director TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a quarterly on-site case management inspection pursuant to a Stipulation and Waiver and Order adopted on 08/19/2022. LPA met with Kylie Whitaker, Health Services Director, and explained purpose of inspection. LPA spoke with Administrator, Andrea Armstrong, by phone at the start of the inspection.

Prior to initiating today's inspection, LPA completed required COVID-19 protocols and confirmed there are no positive cases currently at the facility. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility and was wearing a surgical mask.

During today's inspection, LPA reviewed the "Compliance Binder" and observed it to be organized and to contain tab dividers for each requirement as set forth in in the Stipulation. LPA observed monthly training by an RN, monthly medication room training and weekly staff training to be current. LPA observed documentation for weekly high risk residents and daily door alarm checks to also be current.

LPA observed a copy of the Stipulation to be posted in a conspicuous place inside the front entrance.

HSD advised to place a copy of the Stipulation in the "Compliance Binder" for ease of verifying information at quarterly inspections.

There are no citations issued on this report.

Exit interview. Copy of report provided to Health and Services Director.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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