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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 07/09/2024
Date Signed: 07/09/2024 04:54:12 PM


Document Has Been Signed on 07/09/2024 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:KYLIE WHITAKERFACILITY TYPE:
740
ADDRESS:6825 SUNRISE BLVDTELEPHONE:
(916) 721-0644
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:48CENSUS: 35DATE:
07/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Kylie WhitakerTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to missed medications for (8) residents in the month of June, 2024. LPA met with Kylie Whitaker, Administrator and Julia Wihl, Business Office Manager, and stated the reason for today's inspection.

LPA was contacted by phone by the Administrator on 6/25/24, to report the errors that had just been discovered from an audit in the QMAR system on 6/24/24. An incident report was completed and submitted to the Department on 6/28/24 and noted that (7) of (8) residents (R1-R4; R6- R8) missed medications due to not receiving them timely from the pharmacy and/or responsible persons. For (1) resident (R5), resident missed the medication, Lactulose, on two occasions, due to staff not seeing it on the medication cart.

The Administrator confirmed the information on the incident report that all resident responsible persons were notified as well as each resident's physician. All medications have now been filled and are in the community. Additionally, each resident impacted had an ISP created and were placed on Alert Charting once the error was discovered by the Administrator. No adverse reactions or harm was noted to any of the residents, remain at their normal baseline and staff continue to monitor.

Administrator stated on 7/9/24 that, during the time frame that there were missed medications (6/11/24 through 6/24/24), there was much follow up by staff to obtain the medication and/or refills; however, staff did not elevate the concerns by informing the Health and Services Director or Administrator.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is issued on the 809-D page.

Exit interview. Copy of report and appeal rights provide.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
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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Document Has Been Signed on 07/09/2024 04:54 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2024
Section Cited
CCR
87465(a)(4)

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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
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Staff involved were given disciplinary action and additional medication room training was provided, including an additional (1) hour focusing on medication management.

The HSD will now run a daily report to monitor and review with the Administrator to ensure medications are not missed again.
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Based on the Administrator's statements, and the incident report submitted to the Department, medications were not administered as ordered for (8) residents, during the time frame, 6/11/24 to 6/24/24, which posed an immediat health and safety risk to residents in care. This time frame fell outside of the scheduled medication audit period.
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There is no additional follow up needed as part of this POC.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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