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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 05/10/2023
Date Signed: 05/10/2023 01:28:39 PM


Document Has Been Signed on 05/10/2023 01:28 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



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: 21DATE:
05/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Andrea Armstrong, AdministratorTIME COMPLETED:
01:00 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 Andrea Armstrong, Administrator and Kylie Whitaker, Health Services Director (HSD), and explained purpose of inspection. The last quarterly inspection was conducted on 2/21/23.

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 current documentation for the following requirements:
  • Quarterly Medication Audit - training conducted by either facility Regional Nurse and outside Pharmacy, who alternate every quarter. Last audit was conducted on 3/27/23.
  • High risk residents- LPA observed weekly notes written by HSD based on weekly meeting with facility nurses and Med-Techs.
  • Weekly door checks for alarms and obstruction of door exits. LPA observed documentation to be for last 3 months and week of 5/7/23 to have been initialed as completed.
  • Monthly elopement drills- Last drill conducted on 4/17/23 . Monthly fire drills were conducted on 3/13/23 and on 4/28/23.
  • May training- scheduled every Thursday. LPA reviewed training documentation for 5/4/23- topic was Depression. Training is scheduled for tomorrow, 5/11/23.


During today's inspection, LPA also conducted a health and safety tour of the inside of the facility and did not observe any health and safety risk or personal rights violation.. LPA observed all residents to be in the dining room eating lunch.

There are no citations issued on this report. The next quarterly inspection to be conducted on/around August 2023. 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: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
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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