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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700203
Report Date: 09/20/2024
Date Signed: 09/26/2024 11:55:40 AM

Document Has Been Signed on 09/26/2024 11:55 AM - 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:PEOPLE'S CARE KEYESPORT WAYFACILITY NUMBER:
342700203
ADMINISTRATOR/
DIRECTOR:		KIZZY THORNFACILITY TYPE:
735
ADDRESS:8317 KEYESPORT WAYTELEPHONE:
(916) 735-5620
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 4CENSUS: 4DATE:
09/20/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:John O'Brien, District Manager of Northern California and Michelle Mainez, COO TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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An office meeting was held on 9/20/24 at 10:30 am via Microsoft Teams. The following were in attendance: Licensing Program Regional Manager, Alycia Rayner, Licensing Program Analyst, Sabrina Calzada; Alta California Regional Center Client Services Manager, Toby Golden and Services Coordinator, Hazel Aldax; Licensee COO Michelle Mainez, District Manager Northern California, John O'Brien, and Regional Director Central and Northern California, Mauricio Villatoro.

Alycia Raner explained that the purpose of today's meeting was to discuss client (C1) returning to the facility and being reassessed after spending several weeks in the hospital. The discussion included what steps led to (C1) being hospitalized and how client's behaviors have increasingly escalated to placing (C1) and other clients in the home at risk. Also discussed was how the Licensee's responsibility to pick up a client from the hospital that is ready to be discharged.

Also discussed were alternative placement options to having (C1) return to this facility, steps that have been initiated to be able to place (C1) in a more appropriate setting where his behaviors can be controlled and monitored better, and the timely process it entails.

Alycia Rayner asked that the Licensee provide the Department with an Interim Plan describing how they will take client (C1) back from the hospital. All facility representatives agreed to meet by the next business day with other members of client's care team and determine a plan for client to relocate to a temporary location. A follow up meeting was scheduled for end of next week to discuss the plan.

There are no deficiencies issued in this report.

An exit interview was conducted and a copy of the report was emailed to District Manager, John O'Brien, for his signature. A copy will be signed and returned to LPA Calzada. The signature of the Licensee on this form acknowledges receipt of this document.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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