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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700963
Report Date: 12/21/2023
Date Signed: 12/21/2023 01:08:59 PM


Document Has Been Signed on 12/21/2023 01:08 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: 47DATE:
12/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Christal Anderson and Rae OrtizTIME COMPLETED:
01:15 PM
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On 12/21/23 Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Cassie Yang arrived at the facility unannounced to conduct a case management visit regarding an incident report the department received on 12/14/23. LPAs met with Administrator, Christal Anderson, and explained the purpose of the visit.

LPAs discussed the incident report which occurred on 12/12/23 regarding R1 being "kinda" slapped by S1. The incident was reported by S2 on 12/13/23 to Supervisor, Rae Ortiz. LPAs were informed that S1 is currently on administrative leave and S2 quit immediately.

Based on interview with Administrator, facility followed the proper protocol with reporting the incident to Community Care Licensing (CCLD), Long Term Care Ombudsman (LTCO), and local law enforcement (LE).
Administrator stated internal investigation conducted and determined no findings. Administrator stated as a safety precaution, S1 will not be returning to the facility until cleared by CCLD, LTCO, LE.

At this time, this incident remains under review by the Department.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023
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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