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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700525
Report Date: 10/07/2024
Date Signed: 10/07/2024 02:54:02 PM


Document Has Been Signed on 10/07/2024 02:54 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: 112DATE:
10/07/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Executive Director, Stephen MacDonald TIME COMPLETED:
01:00 PM
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A virtual meeting was conduct on 10/07/24 with the facility to discuss a situation at the facility regarding resident, R1. Facility Executive Director (ED) , Stephen MacDonald, Facility’s representatives and CCL staff, Regional Manager, Alycia Rayner , Licensing Program Analyst Talwinder Bains, and Licensing Program Manager, Anthony Perez were present. Also in attendance today are representatives from the Long-Term Care Ombudsman (LTCO), Byron Toliver.

Department has been made aware that R1 was not paying their share of cost for monthly charges and was given 1st written notice by the facility on 07/12/2024 which indicated the amount of $5464.80. R1 did not take any action on 1st notice, so facility issued a 2nd written notice to R1 on 08/20/2024 per admission agreement and facility’s policy. R1 was non complaint with facility’s payment policy, therefore, facility issued a 30- day Eviction Notice to R1 on 09/26/2024. LPA spoke to R1 regarding this matter in August and September 2024, by thyself and with Long Term Care Ombudsman, Byron Toliver and each time the conversation went for 30-45 minutes. During these interactions with R1, R1 acknowledged the issues with their pending payments with facility and were aware that it can lead to possible eviction if not being addressed in timely way. Record review and gathered information indicated that R1 was not taking necessary steps to resolve this matter despite being provided with different resources and assistance by LPA, LTCO and Facility Staff. At this point , it appeared that R1 might have a undiagnosed health condition which is causing them a delay not to take required actions to take care of their health and financial needs which can effect their well being and possible eviction.

During this meeting, it was discussed that the facility will send a request to Sacramento County for possible appointment of legal conservator for R1 to ensure their health and safety needs.



No citations were issued per Title 22 Regulations. Exit interview is conducted with ED via phone.
Copy of the report was sent via email and ED will sign and send it back to LPA via email by 10/08/24 by 5pm.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2024
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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