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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700963
Report Date: 09/04/2024
Date Signed: 09/04/2024 12:50:58 PM


Document Has Been Signed on 09/04/2024 12:50 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:OARS AT GREENBACK LANE, THEFACILITY NUMBER:
342700963
ADMINISTRATOR:CHRISTAL ANDERSONFACILITY TYPE:
740
ADDRESS:6550 GREENBACK LANETELEPHONE:
(916) 212-0388
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:57CENSUS: 49DATE:
09/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Administrator- Christal AndersonTIME COMPLETED:
12:55 PM
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On 09/04/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a case management visit regarding an absent without incident report the department received via fax on 08/26/24. LPA met with Executive Director (ED) Christal Anderson and explained the purpose of the visit.

The incident occurred on 08/23/24 at approximately 11:35 AM facility staff observed R1 to be missing. Staff conducted a search throughout the community. Staff was unable to locate R1. Facility called 911, police conducted a search and found that R1 still owns a home in the area. R1 was located at their home and returned back to the community around 3:30 with no injuries. Facility was unaware that R1 has a home in the area. Based on R1's LIC602 Physician's Report, signed on 01/29/24, indicated that R1 was deemed unable to leave the facility unassisted.

LPA and ED discussed how R1 has only been living at the facility for two months and staff are still learning about R1. R1 does have an appointment with their PCP tomorrow for a revaluation. R1 now has a wanderguard in place and has the project life saver tracker with the local police department. When R1 was brought back into the community they had apologized to staff and stated they did not know they could not leave the facility unassisted. Staff have been coming into work earlier to observe R1 to find any possible triggers. Additionally, facility is taking R1 on more outings in the community with other residents and staff.

At this time, no deficiencies were cited during today's visit.



Exit interview conducted and copy of the report left at the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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