342700077-11-15-2023-59-AS-SCAA-CXM3FM-20231115171257

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 11/15/2023
Date Signed: 11/15/2023 05:13:03 PM

Document Has Been Signed on 11/15/2023 05:13 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, THE		FACILITY NUMBER:	342700077
ADMINISTRATOR:	KYLIE WHITAKER		FACILITY TYPE:	740
ADDRESS:	6825 SUNRISE BLVD		TELEPHONE:	(916) 721-0644
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	48	CENSUS: 21	DATE:	11/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Kylie Whitaker, Administrator		TIME COMPLETED:	05:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Kylie Whitaker, Administrator, and explained purpose of inspection. Also present was Julia Wihl, Business Office Manager (BOM). The facility is licensed for 48 non-ambulatory residents who have a diagnosis of Dementia and there is an approved hospice waiver for 12 residents. There are currently (8) residents on hospice. LPA, Administrator and BOM toured the interior and exterior of the facility including several resident rooms with a private or shared bathroom, medication room, dining room, activity rooms, salon, spa tub room, kitchen, and common areas. LPA observed the facility to be clean, in good repair, odor free and the bathrooms to have paper towels, soap, and trash cans with lids. There are 20-second hand-washing posters throughout. Fire extinguishers observed throughout and were last serviced on 3/30/23. Inside temperature measured 72F and hot water measured 115F in a guest restroom. LPA observed sufficient 2+day perishable and 7+day non-perishable food. Kitchen was observed to be clean, including the ice machine which is serviced quarterly. Documentation is posted for refrigerator/freezer temperature readings. Kitchen extinguisher due for yearly serving by 2/1/24.All (3) exit doors and front entrance door are equipped with a (30) second egress door alarm. Signage is posted. There are (2) activity areas with a variety of activities offered to residents. There is sufficient PPE on site and toxins and hygiene products are kept locked. There were no hazardous items observed in resident areas. There is an enclosed courtyard with gardening planters for residents and there are no pools or ponds. LPA reviewed medications for (5) residents, comparing orders to medications being administered. There were no discrepancies found. Med-Tech staff use an e-MAR to manage medication administration. There is a mini-fridge in the medication room for medications needing refrigeration. Binders are also kept in the medication room, including a file for faxed refill requests. cont on 809C-1..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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, THE	FACILITY NUMBER: 342700077
	VISIT DATE: 11/15/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

809C-1... LPA reviewed (10) of (21) resident files and found them to be organized and contain current paperwork. All physician reports and care plans were completed within the last (12) months or more recently.
LPA reviewed (10) staff files and found them to be organized and contain current documentation of training completed. Staff complete initial and ongoing required training through an approved on-line vendor. All staff is current with First Aid. The facility will host an in-person CPR training this month for several staff.

LPA observed multiple staff present and was advised there is a nurse on site 24/7, 5 days per week. LPA reviewed the Infection Control Plan (LIC9282). Administrator stated staff receive regular training on Infection Control, including on hand hygiene and use of PPE.

LPA requested a copy of LIC500 and current liability insurance be emailed to CCLD by 11/30/2023.

There were no deficiencies observed during today's inspection.

Exit interview. Copy of report provided to the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2