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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 09/12/2023
Date Signed: 09/12/2023 12:18:24 PM


Document Has Been Signed on 09/12/2023 12:18 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
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: 108DATE:
09/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Business Office Manager,Danielle Twitchell TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 09/12/23 to conduct a case management inspection to follow up on a recent AWOL for R1 at the facility. LPA met with facility Business Office Manager, Danielle Twitchell and explained the purpose of the visit. LPA was screened by facility staff upon entry.

R1’s AWOL Incident- The facility submitted a completed Unusual Incident/Injury Report (LIC624) on 09/05/23 regarding resident (R1) leaving the facility unattended on 09/02/23 , at approximately 6am. Per incident report, R1 was found outside the facility unassisted by facility staff . R1 was brought back to the facility uninjured by facility staff. LPA followed up with facility after this incident and gathered information for R1 including LIC602. Facility notified R1s doctor and family regarding this AWOL incident.

R1's physician's report dated 06/08/23 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 implementing measures to prevent the AWOL incidents from occurring in the future to ensure the health and safety of residents in care.

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: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
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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