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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 04/24/2024
Date Signed: 04/24/2024 10:37:00 AM


Document Has Been Signed on 04/24/2024 10:37 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: 118DATE:
04/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Stephen MacDonaldTIME COMPLETED:
10:45 AM
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Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility unannounced on 04/24/24 to do case management visit . LPAs met with administrator Stephen Macdonald and explained the purpose of the visit.

Department followed up on Incident Report and SOC 341 sent by facility on 04/19/24 for date -04/18/24 regarding resident, R1. Facility notified law enforcement and long term care ombudsman (LTCO) regarding this incident. Department conducted interview with resident, R1 regarding this incident during today’s visit.

LPAs requested documents related to this incident and facility will submit all documents by 04/25/24 by 5pm.

At this time, this case in under review and department will do follow up as needed.
No citations were issued per Title 22 Regulations.
Exit interview conducted and copy of the report left at facility.







SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
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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