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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 05/22/2024
Date Signed: 05/22/2024 04:25:31 PM


Document Has Been Signed on 05/22/2024 04:25 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: 36DATE:
05/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Kylie Whitaker, Administrator TIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a follow up case management inspection related to an incident report recently submitted involving a resident (R1) who went to the hospital on 5/11/24. LPA met with Kylie Whitaker, Administrator and stated the reason for today's inspection. LPA also met with Julia Wihl, Business Office Manager and Jasmine Juchniewicz, Health and Services Director.

LPA discussed the incident in more detail with the Administrator and the other (2) staff present. The Administrator confirmed that resident (R1) returned from the hospital on 5/14/24, under hospice care, and was diagnosed with mild colostomy prolapse. The Administrator confirmed that hospice staff will be providing all care relating to colostomy bag and resident has been placed on more frequent health/safety checks.
Also discussed was an incident report to be submitted for resident (R2) who was sent to the ER for being found unresponsive and returned to the facility shortly with antibiotics for a UTI. LPA was also provided with a copy of a death certificate for a resident (R3) who passed recently, while under hospice care.

LPA, Administrator and Business Office Director toured the facility. LPA observed it to be clean, odor free and residents to be participating in activities. LPA observed (2) staff in the medication room, as scheduled during the "am" and "pm" shifts. The Administrator stated staffing remains sufficient, as a 1:8 ratio, to provide the care needed for all residents. During today's inspection, LPA observed a non-emergency medical transport arrive to assist with resident (R4), but resident was not determined to have needed additional medical treatment.

There were no deficiencies observed during today's inspection.

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: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024
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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