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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700077
Report Date: 11/12/2025
Date Signed: 11/12/2025 06:14:38 PM

Document Has Been Signed on 11/12/2025 06:14 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/
DIRECTOR:		AMY BOLLIERFACILITY TYPE:
740
ADDRESS:6825 SUNRISE BLVDTELEPHONE:
(916) 721-0644
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 48CENSUS: 38DATE:
11/12/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Brenda Cobos, Administrator TIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Sabrina Calzada, arrived unannounced to conduct a case management inspection to follow up on a previously case management inspection conducted on August 28, 2025. LPA met with Brenda Cobos, Administrator, and stated the reason for today's inspection.

This case management is for an incident that occurred on August 18, 2025 (1:50 pm) involving staff (S1) and resident (R1). Staff (S2/S3) reported they were walking by (R1's) room and heard (R1) screaming, and the door was closed and locked. When they entered the room, they observed (R1) to be sitting in their wheelchair, fully dressed, crying, rubbing their hands as if in pain. (S2/S3) reported they noticed bruising on (R1's) hands, but (R1) was unable to describe what the bruising was caused from. After (S2/S3) arrived to assist, (S1) left the room, making disparaging comments that they hope (R1) "falls, declines and goes on hospice". (S1) returned to (R1's) room a few minutes later holding a garbage bag, and (S2/S3) heard (S1) call (R1) an inappropriate name, three times, before leaving again.

The incident was reported via a SOC 341, completed on 8/19/25, and mentions that (R1) was crying, rubbing their hands and observed to have bruising on "both hands". This SOC341 notes both physical and verbal abuse was reported and that the Ombudsman's office was phoned on 8/18/25 (2:30 pm) to report both types of abuse. The Ombudsman conducted a follow up inspection at the facility on August 22, 2025 (4:00 pm) and was provided with an email summary stating (R1) was observed with "bruises on both hands".

The Ombudsman indicated he received a second SOC341, on August 25, 2025, for the same incident on 8/18/25, and this report only mentions the alleged physical abuse (bruising) and does not mention any verbal abuse. This report indicates the police were notified on August 22, 2025 (7:00 pm)
*cont on 809C-1..
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 11/12/2025
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809C-1.. The Ombudsman noted on August 27, 2025 that he spoke to (S2) and (S3) who emailed the Administrator the same night (8/18/25) regarding the verbal and physical abuse they observed.

LPA and the Ombudsman discussed with the Administrator on August 28, 2025, how the second SOC341 didn't address the verbal abuse witnessed. The administrator acknowledged the error in reporting, agreed to amend the report to include verbal abuse, and confirmed (S1) was placed on administrative leave, last worked in the morning on August 22, 2025, and the police were called that day. The Ombudsman stated he talked to both staff, (S2/S3) and (S2) confirmed that they heard (S1) call resident (R1) a "devil" three times but this part of the verbal abuse was "not reported" to the administrator, which she confirmed.

Detailed notes were provided to the Department showing a timeline of events from August 18, 2025 through September 4, 2025. The notes document that (R1) returned from the Emergency Room on August 18, 2025 (4:00 am). Interviews conducted during the investigation confirm that (R1) received an Intra Venous (IV) while there, and it was placed in their right hand. These notes states that one and/or both family members spoke with a facility representative on multiple occasions, beginning on August 18, 2025 (2:22 pm). One family member stated she had a lengthy phone call with facility managers on August 21, 2025 (3:44 pm) and "at no time during the call were abuse allegations mentioned by any of the three directors".

On August 22, 2025, the Administrator stated to a family member who was visiting that there would be an internal investigation opened up regarding the allegations. There was a follow up phone call from the Administrator on August 25, 2025 to state that the caregiver stories "don't align and are changing".

LPA contacted (S2/S3) on September 19, 2025 and confirmed with each staff that what was previously reported to the facility, the Ombudsman's office and to local law enforcement was correct. (R1) did not return to the facility after August 22, 2025.

Based on information obtained during the investigation, there is a preponderance of evidence to substantiate that (S1) verbally abused (R1) on August 18, 2025 (1:50 pm). Additionally, the facility did not timely report the suspected abuse to (R1's) family member within (24) hours.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (2) deficiencies issued on the 9099-D page. Exit interview. Copy of report and appeal rights provided to the Administrator.
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/12/2025 06:14 PM - It Cannot Be Edited


Created By: Sabrina Calzada On 11/12/2025 at 04:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 11/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/13/2025
Section Cited
CCR
87413(a)(2)

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87413 Personnel - Operations(a) In each facility: (2) Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. This requirement is not met as evidenced by:
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Licensee/Administrator provided in-service to staff in September, 2025, following the incident, using a slide show provided by the Ombudsman's office.
Documentation to LPA by 11/14/25.
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Based on interviews conducted and documentation reviewed, the Licensee did not ensure that (R1) was not verbally abused by staff (S1) on August 18, 2025 (approx 1:50 pm), which poses an immediate health and safety risk or personal rights violation , to residents in care.
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Type B
11/26/2025
Section Cited
CCR87211(a)(1)

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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement is not met as evidenced by:
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Licensee/Administrator agree to review Regulation 87211 and provide in-Serivce to all managers and staff-

Documentation due by 11/30/25.
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Based on documentation reviewed and interviews conducted, the Licensee did not ensure that (R1's) responsible person/s were notified timely, within (24) hours of suspected abuse and a written report was not provided to the responsible person/s within (7) days of the alleged abuse on August 18, 2025, which poses a potential health and safety risk to residents in care.
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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.
Maribeth Senty
NAME OF LICENSING PROGRAM MANAGER:
Sabrina Calzada
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2025


LIC809 (FAS) - (06/04)
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