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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 10/18/2023
Date Signed: 10/18/2023 04:54:20 PM


Document Has Been Signed on 10/18/2023 04:54 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: 23DATE:
10/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Kylie Whitaker, Administrator TIME COMPLETED:
05:00 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 Kylie Whitaker, Administrator, and Jasmine Juchniewicz, Health and Services Director since August 2023, and explained purpose of inspection. The last quarterly inspection was conducted on 7/26/23.

During today's inspection, LPA reviewed the "Compliance Binder" and observed it to be organized and 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 an outside Pharmacy RN, on 7/30/23 thru 9/24/23.
  • High risk residents- LPA observed weekly notes filed, thru 10/11/23, written by HSD based on weekly meeting with facility nurses and Med-Techs every Wednesday. Residents with recent concerns are discussed. Today's notes to be filed.
  • Weekly door checks for alarms and obstruction of door exits. LPA observed documentation on each log to be for the last 3 months to have been initialed as completed. In addition, the Maintenance Director conducts quarterly door checks on different shifts each time.
  • Monthly elopement drills- Elopement drills are now being conducted on a weekly basis, per facility protocols . Monthly fire drills were conducted in July, August, September and October thru current date.
  • August-October training- scheduled every Thursday. LPA reviewed training documentation and observed a variety of topics including , COPD, UTI's, fall prevention, pain management and more topics.

LPA 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 many residents to be throughout the community. LPA also was provided with paperwork for the Administrator change, effective 8/15/23, and with confirmation of it being faxed to the Department the same day. LPA to update the Administrator of record.
There are no citations issued on this report. The next quarterly inspection to be conducted on/around January 2024. Exit interview. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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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