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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 08/08/2023
Date Signed: 08/08/2023 11:08:00 AM


Document Has Been Signed on 08/08/2023 11:08 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:ALMOND HEIGHTSFACILITY NUMBER:
342700525
ADMINISTRATOR:MACDONALD, STEPHENFACILITY TYPE:
740
ADDRESS:8685 GREENBACK LNTELEPHONE:
(916) 542-7988
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:145CENSUS: 113DATE:
08/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Stephen Macdonald TIME COMPLETED:
11:20 AM
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On 08/08/23, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 07/18/23.

LPA met with Administrator, Stephen MacDonald and explained reason for visit.

Special Incident Report (LIC 624) and Abuse Report (SOC341) was submitted by facility on 07/18/23 to CCL stated that R1 alleged that R1 was sexually violated at the facility on 07/18/23. Incident report indicated on 07/18/23, R1s family informed the Executive Director, Stephen MacDonald that R1 was sexually violated. R1 was unable to verbally communicate (due to R1s medical condition). Per R1s family, R1 told the family regarding the incident and family notified facility immediately. Facility notified R1s physician, law enforcement and responsible party on 07/18/23 regarding this incident. Facility called 9-1-1 and law enforcement arrived and investigated. It was advised to family that resident be seen in ER. R1 was seen by their physician on 07/19/23 and blood test and other lab tests have been conducted. Results came as ‘unremarkable’. Lab results indicated that ‘No antibodies to HCV detected; a nonreactive result does not exclude the possibility of exposure to HCV’ for R1. Per facility, R1 was back to their baseline and doing well for now. R1 has been living at the facility since 07/05/21.

Based on this information, no citations were observed or cited during this visit.

Exit interview was conducted and copy of the report has been provided.




SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
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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