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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 03/01/2024
Date Signed: 03/01/2024 04:50:42 PM


Document Has Been Signed on 03/01/2024 04:50 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: 29DATE:
03/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kylie Whitaker, Administrator TIME COMPLETED:
04:50 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 2/1/24, involving two residents. LPA met with Kylie Whitaker, Administrator, and stated the reason for the inspection.

Prior to today's inspection, LPA and the Administrator discussed the reported altercation immediately following when it took place, on 2/1/24, and in January 2024, when an initial altercation took place. . A SOC341 (Report of Suspected Abuse) was submitted by the facility following the incident along with an incident report. Neither resident sustained any injuries, and following the 2/1/24 incident, the facility took several interventions after each incident to prevent any future altercations from reoccurring. There have been no subsequent incidents where (R1) has hit or pushed (R2); however, (R1) recently raised their hand to appear to try and strike (R2); but staff was nearby and able to prevent any physical contact between the residents. The facility is currently redirecting (R2) to activities when they seem more confused and allowing (R2) to visit with (R1), if desired, when staff can provide stand-by assistance.

The Department received a second SOC341, on 2/22/24, from a third party for the incident from 2/1/24 and also for an incident in January 2024, but the information contained did not match all the information reported by the facility. The Administrator stated (R2) never fell on the floor on 2/1/24. The Ombudsman made an inspection on/around 2/28/24 to discuss the incident, and there were no follow-up concerns. The Administrator stated following the incident on 2/1/24, (R1) and (R2)'s medical providers were contacted and each resident was reassessed by a social worker and nurse. LPA observed (R2) to be resting today.

LPA and Administrator also discussed other incident reports recently submitted to the Department and toured the facility. LPA observed several residents enjoying a healthy snack in the activity area, several residents in their rooms, and three dining tables set up in a smaller dining area for residents who need closer monitoring during meals. There as no deficiencies issued in this report as the facility timely reported the incident to the Department, law enforcement, family members and physicians, and there were no injuries sustained by (R2). Exit interview. Copy of report provided to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024
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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