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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 01/18/2024
Date Signed: 01/18/2024 12:31:42 PM


Document Has Been Signed on 01/18/2024 12:31 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:KYLIE WHITAKERFACILITY TYPE:
740
ADDRESS:6825 SUNRISE BLVDTELEPHONE:
(916) 721-0644
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:48CENSUS: 25DATE:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Kylie Whitaker, Administrator TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to an incident reported to the Department on 1/17/24 at 7:27 pm. LPA met with Kylie Whitaker, Administrator, Julia Wihl, Business Office Manager (BOM), and Jasmine Juchniewicz, Health and Services Director, and explained purpose of the inspection.

LPA discussed the incident occurring in the early hours of 1/17/24 involving resident (R1) having an unwitnessed fall and being sent to the emergency room. (R1) was sent out immediately following the fall and admitted for a left hip fracture and received surgery in the hospital later that day. The Administrator indicated that (R1) was a new resident and considered a fall risk, like most residents. (R1) had a bed alarm on his bed purchased by his family, but the bed alarm was somewhat faulty.

Staff reported (R1) fell in the bathroom and they were alerted when they heard (R1) fall. Administrator stated (R1) is provided hourly assistance with toileting needs and was recently attended to just prior to the fall. The Administrator stated (R1's) family member indicated they will purchase a higher quality bed alarm for when (R1) returns to the community after receiving rehabilitation services at a skilled nursing facility. An incident report will be submitted to the Department by 1/24/24.

The Administrator also mentioned another resident (R2) who was recently admitted to the community and has been placed on hospice after contracting Covid with a diagnosis of Post Covid Syndrome. (R2) contracted Covid at a skilled nursing facility prior to returning to the facility. A hospice notification was submitted within (5) days of (R2) starting hospice services.

There are no deficiencies issued in this report.

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: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
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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