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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 07/26/2023
Date Signed: 07/26/2023 05:16:51 PM


Document Has Been Signed on 07/26/2023 05:16 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: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:
07/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Andrea Armstrong, Administrator TIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to several incident reports submitted to the Department recently. LPA met with Business Office Director who contacted the Administrator and Health and Services Director (HSD) by phone. LPA met with HSD in person and the Administrator by phone.

LPA discussed incident reports as follows:

Resident (R1) had an unwitnesed fall on 7/11/23 and received first aid by ambulance crew for the skin tear sustained. Resident's family member refused additional medical treatment. Resident was previously admitted to hospice and due to change in medications had been declining rapidly. Resident passed on 7/16/23 and an LIC624A was submitted to the Department on 7/17/23. Hospice was notified of the fall.

Resident R2 became very agitated on 7/11/23 (8:00 pm) and was physically aggressive with a caregiver so was sent out to the ER. Resident returned the same day without any new orders or a diagnosis; however, a UTI was ruled out. Resident's PCP was faxed requesting a home visit. Resident showed aggression again with staff on 7/23/23 and was sent to ER, returning the same day, with an order change for PRN medication. Labs were completed in the hospital. Resident was seen by the PCP the next day and lab results were evaluated. Resident was given a new scheduled and PRN medication to start on 7/25/23. Resident has not had any subsequent incidents. The facility will continue to monitor R2's behavior with the new medication changes. LPA was unable to speak to resident due to resident sleeping at the time of the inspection.

There are no deficiencies issued on this report.

Exit interview. Copy of report provided to HSD.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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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