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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 10/09/2020
Date Signed: 10/09/2020 03:58:56 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: 111DATE:
10/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Danielle Twitchell, Acting Executive DirectorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Wolter contacted the facility on 10/09/2020 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 10/09/2020. LPA spoke to Acting Executive Director (ED), Danielle Twitchell, and explained the purpose of the call.

Incident report stated that on 10/05/2020 a resident (R1) disclosed an alleged event that occurred with a caregiver from an outside agency a few weeks prior. Upon learning of the event Acting ED cross reported to all required parties and the caregiver in question has not returned to the facility.

LPA and Acting ED discussed the cross reporting further and what steps were taken after the alleged incident was disclosed. The caregiver involved has not returned to the facility and the incident was reported to the staffing agency. Sheriffs department, ombudsman, responsible party and primary physician were all notified. Acting ED stated R1 has been fine following the incident.

LPA requested that Acting ED send CCL a copy of the SOC 341 and Sheriff's Incident number.

No deficiencies are being cited today. Further investigation may be required into the alleged event.

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: 10/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020
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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