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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 03/20/2024
Date Signed: 03/20/2024 01:17:25 PM


Document Has Been Signed on 03/20/2024 01:17 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: 121DATE:
03/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director -Stephen Macdonald TIME COMPLETED:
01:30 PM
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 Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility unannounced on 03/20/24 to conduct a case management inspection to follow up on a choking incident on 03/11/24 for resident, R1 at the facility. LPAs met with Executive Director (ED), Stephan McDonald and explained the purpose of the visit.

Facility submitted incident report to department on 03/18/24 about resident, R1 who had choking incident on 03/11/24 in the main dining room around 10.30am. Facility staff took appropriate measures and performed Heimlick Manuever on R1. R1 was back to their baseline after this incident. Facility notified R1s family, hospice agency, physician and other required agencies as required.

After reviewing the incident report and information gathered, it has been determined that facility took appropriate measures to address R1s choking incident on 03/11/24. No citations were observed or cited per Title 22 Regulations. Exit interview 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: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
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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