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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 11/22/2022
Date Signed: 11/22/2022 11:24:11 AM


Document Has Been Signed on 11/22/2022 11:24 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
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: 92DATE:
11/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Stephen Macdonald TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 11/22/22 to conduct a case management inspection to follow up on a recent AWOL for R1 at the facility. LPA met with facility Administrator Stephen Macdonald and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms . LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn surgical mask. LPA was screened by facility staff upon entry.

R1’s AWOL Incidents- The facility submitted a completed Unusual Incident/Injury Report (LIC624) regarding resident (R1) leaving the facility unattended on 10/18/22 , at approximately 2.30pm and on 11/11/22 at approximately 2.19pm. Per incident reports, R1 was found outside the facility unassisted by facility staff in both incidents. R1 was brought back to facility uninjured with facility staff. LPA followed up with facility after these incidents and gathered information for R1 including LIC602, Admission Agreement and care notes. Facility notified R1s doctor and family regarding these AWOL incidents.

R1's physician's report indicates that resident has diagnosis of dementia and cannot leave the facility unassisted. Resident has not tried to leave facility again and has been communicating better with the staff if R1 needs something. The facility has been continuously addressing implementing measures to prevent the AWOL incidents from occurring in the future to ensure the health and safety of residents in care.

LPA did facility tour during today's visit, interviewed facility staff and R1 regarding these incidents. Several topics have been discussed during today's visit.

No citations were issued at this time and only Technical Advisory has been issued to the facility. Exit interview conducted. Copy of report provided to facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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