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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700202
Report Date: 05/29/2024
Date Signed: 05/29/2024 12:13:19 PM


Document Has Been Signed on 05/29/2024 12:13 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:VILLAGE AT HERITAGE PARK, THEFACILITY NUMBER:
342700202
ADMINISTRATOR:KENT MULKEYFACILITY TYPE:
740
ADDRESS:2001 ROSE ARBOR DRIVETELEPHONE:
(916) 216-8958
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:108CENSUS: 39DATE:
05/29/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Anntoinette Edwards, Executive DirectorTIME COMPLETED:
01:00 PM
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On May 29, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a Case Management Legal / compliance visit. LPA met with Anntonette Edwards, Executive Director, (ED) and informed her the reason for the visit.

The facility states now that the probationary period is over for the stipulation and there's no longer a Memory Care Unit at the facility, is the 'Plan of Correction' excepted?

Also, LPA received a call from the ED wanting some information regarding a resident that has resided at the facility for more than 5 years. The resident now needs a higher level of care. The resident is a 2 man assist and is refusing to use a hoyer-lift which has endangered facility staff. More than 10 staff have been injured and was on Workman's Compensation, which is also causing the facility to be insufficient. The question is how long will the facility be able to care for the resident and what about the other residents and their care?

LPA and ED will discuss this issue with the Licensing Program Manager for ideas of care for the resident.

No citations were issued.

An exit interview was conducted and a copy of this report was given to Anntonette.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024
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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