342700077-4-19-2023-59-AS-MSEY-CR3RWP-20230420132327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700077
Report Date: 04/19/2023
Date Signed: 04/19/2023 02:38:19 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
03/14/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230314140815

FACILITY NAME:	COURTE AT CITRUS HEIGHTS, THE		FACILITY NUMBER:	342700077
ADMINISTRATOR:	ARMSTRONG, ANDREA		FACILITY TYPE:	740
ADDRESS:	6825 SUNRISE BLVD		TELEPHONE:	(916) 721-0644
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	48	CENSUS: 20	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Andrea Armstrong,		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude and deliver findings to a complaint received on 3/14/23. LPA met with Andrea Armstrong, Administrator, and explained purpose of inspection. LPA completed required COVID-19 department protocols and was wearing a surgical mask.

During the investigation, LPA interviewed the facility Administrator and (3) individuals who had knowledge of resident's (R1) placement at the facility. LPA also reviewed documentation, including R1's physician's report, pre-assessment, care plan and other documents. The results of the investigation are as follows:

The complaint alleges that after resident was sent to ER for suicidal ideations, the facility refused to take the resident back and did not issue a 30-day eviction notice.

A hospital representative who had knowledge of resident's initial evaluation, stated R1's medical situation was discussed with the facility on 2/28/23 when resident was last discharged from the hospital, just prior to being admitted to the facility. The representative stated that the facility assured hospital staff they could provide for R1's needs, knowing he was an elopement risk. ** cont on 90099C(1). ..

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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 59-AS-20230314140815

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: COURTE AT CITRUS HEIGHTS, THE	FACILITY NUMBER: 342700077
	VISIT DATE: 04/19/2023

NARRATIVE

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9099C(1).. The Administrator stated on 3/16/23, that at the time of assessment, on 2/28/23, R1 was taking his medications, not displaying any suicidal ideations, but was exit seeking as noted on the physician's report. Upon move in, resident was "very pleasant" after some recent medication changes and a spinal tap. Administrator explained that from Thursday, 3/9/23, through Monday, 3/13/23, resident then refused all his ordered medications, which included Depakote, and told his family member, twice, he wanted to commit suicide. Resident then subsequently eloped from the facility twice, on 3/12/23 and on 3/13/23. Administrator confirmed resident remained hospitalized and she requested a mental evaluation be done based on resident's suicidal ideations. A hospital representative stated R1 received a full psychological evaluation with a licensed clinical social worker who determined that he does not meet criteria for a 5150.

Administrator stated to LPA on 3/16/23 that the facility hadn't officially issued an eviction notice to R1 or to his responsible person but told the family resident can return to the community if on 1:1 supervision as
he can read the signs saying "hold for 30 seconds", is awake at night, and even with additional staffing, as required per the Stipulation, he is able to get out of the facility.

Resident's family member stated to LPA on 3/22/23 that R1 will not be returning to the community, and she removed his belongings last Saturday, 3/18/23 and is working on finding new placement. Resident's family member stated that she was aware R1 was refusing medications and then stopped taking them 100%, on/around 3/10/23, eloping on the following and next day. R1's family member indicated she believes R1 is taking his meds again now since being hospitalized and is certain R1 spoke with the hospital social worker and told him "he doesn't want to take his medications and he wanted to die".

LPA reviewed multiple reports faxed to R1's doctor, dated 3/5/23 through 3/13/23, where R1 refused his medications at multiple times on each day. An Interim Service Plan was implemented on 3/11/23 and related staff training was conducted on 3/13/23. The Administrator stated on 4/19/23 that an eviction notice was never issued and resident's family member understood that 1:1 supervision was needed for resident to return. Additionally, the hospital indicated they are not able to pay for the 1:1 care resident would need to return.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- a finding meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview. Copy of report provided to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

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