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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 09/12/2022
Date Signed: 09/12/2022 02:28:37 PM


Document Has Been Signed on 09/12/2022 02:28 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ALMOND HEIGHTSFACILITY NUMBER:
342700525
ADMINISTRATOR:MACDONALD, STEPHENFACILITY TYPE:
740
ADDRESS:8685 GREENBACK LNTELEPHONE:
(916) 542-7988
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:145CENSUS: 90DATE:
09/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Stephen MacdonaldTIME COMPLETED:
03:00 PM
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On 09/12/22, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility and met with Administrator, Stephen Macdonald , to follow-up on an Unusual Incident Report (IR) and SOC 341 received by the department on 08/24/22 for resident (R1) regrading an incident happened on 08/22/22. Facility currently does not have any COVID-19 positive cases. LPA wore surgical mask while in the facility. LPA was screened by facility staff upon entry.

IR and SOC 341 received on 08/24/22 stated that R1s family reported to facility on 08/22/22 around 9pm that R1 was 'thrown on the ground and slapped'. Facility staff and administrator reported the incident to police on the same day with case number # 22-249421 and police interviewed R1, facility staff and family. Administrator also interviewed facility staff on 08/22/22 and ensured the safety of R1 at the facility. Facility did report the incident to Ombudsman on 08/24/22. After the total skin check of R1 by staff and interviewees conducted on 08/22/22 , there was no sign of injury or bruise noted with R1 with presence of family . Facility did notify R1s physician as well regarding the incident.

During today's visit, LPA interviewed facility staff regarding the incident. Per staff, R1 had diagnosis of dementia and R1s health was declining recently. R1 did require 2 or more staff assistance with her care needs. R1 was living at the facility since 12/18/19. R1s had a change in condition on 09/03/22 and she was transferred to hospital. R1 came back from hospital on 09/08/22 with hospice care and expired on 09/12/22 at the facility. Per facility staff, facility provide care to R1 per R1s care and service plan. Per facility staff, R1s physician, family and facility staff were aware regarding R1s health condition.

LPA and administrator toured the facility to check the health and safety of residents in care.
No deficiencies are cited during today's visit. Exit interview was conducted with Administrator and a copy of this report provided. The signature of the Administrator on this form acknowledges receipt of this document.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022
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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