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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 10/07/2020
Date Signed: 10/07/2020 03:45:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ALMOND HEIGHTSFACILITY NUMBER:
342700525
ADMINISTRATOR:AGUIAR, TERRIFACILITY TYPE:
740
ADDRESS:8685 GREENBACK LNTELEPHONE:
(916) 542-7988
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:145CENSUS: 110DATE:
10/07/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Amrita Sapkota, CFL Coordinator TIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Wolter contacted the facility on 10/07/2020 via telephone due to COVID-19 and precautionary measures to follow up on an Incident Report (LIC 624) that Community Care Licensing (CCL) received on 10/04/2020. LPA spoke to Amrita Sapkota (S1), Connections for Living (CFL) coordinator and explained the purpose of the call.

Incident report stated that on 09/23/2020 resident (R1) exhibited aggressive behavior and facility staff was unable to redirect or calm the resident down and resident was sent to the ER for further evaluation. R1 spent 5 days in the hospital and returned to the facility with new medication orders and was doing better at that time.

LPA spoke with Karen Huckabee (S2), CFL Director for an update on how R1 has been since returning to the facility. S2 told LPA that R1 began exhibiting aggressive behaviors again and was sent to the ER on 10/05/2020. S2 stated that they are working with the hospital discharge planner to ensure that the needs of the resident can be met by the facility; should the facility not be able to meet the needs of the resident they will discuss alternative options with the family. At this time R1 remains in the hospital and facility will keep CCL informed with updates as they arise.

No deficiencies are being cited as a result of this call.
Exit interview conducted and copy of report emailed to facility. Facility representative to sign the report and email or fax CCL a copy. Facility should also retain a copy for their records.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Danyle WolterTELEPHONE: (916) 708-5307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020
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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