347001498-7-1-2026-59-AS-SCAA-DVKUPB-20260701154518

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347001498
Report Date: 07/01/2026
Date Signed: 07/01/2026 03:45:27 PM

Document Has Been Signed on 07/01/2026 03:45 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:	CITRUS HEIGHTS TERRACE		FACILITY NUMBER:	347001498
ADMINISTRATOR/ DIRECTOR:	MAGDA LUIS		FACILITY TYPE:	740
ADDRESS:	7952 OLD AUBURN ROAD		TELEPHONE:	(916) 727-4400
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY: 49		CENSUS: 46	DATE:	07/01/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Rachael Robert, Resient Care Coordinator		TIME VISIT/ INSPECTION COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection and met with Rachael Robert, Resident Care Coordinator (RCC) and Administrator Designee. LPA stated the reason for the inspection was to follow up on several incident reports (LIC624) submitted to the Department in June, 2026. There are currently (4) residents under hospice care. LPA and the RCC discussed the following: Resident (R1) had an unwitnessed fall on 6/26/2026 ( 5:00 pm), was evaluated by emergency personnel and sent out for further medical attention. (R1) indicated to care staff that they hit their head but did not complain of pain. (R1) returned the same day with no injuries and with new orders to use a walker and start Home Health (Physical Therapy). (R1's) care plan was updated to note the use of a walker. (R1) is making progress with using their walker and PT visits 2x/week. Resident (R2) complained of chest pain on 5/30/26 (11:50 am) and on 6/10/26 (5:20 pm). R2 was evaluated by emergency personnel and sent out for further medical attention. (R2) returned to the community following each hospital visit and test results noted there were no signs of a heart attack, blood clot or pneumonia. (R2) was advised to follow up with their primary care physician. Staff has continued to monitor (R2) for any changes in condition. No changes were made to resident's medications after each visit. Resident (R3) had an unwitnesed fall on 6/8/26 (5:20 pm), after becoming dizzy following dinner. (R3) fell on their left side, and reported pain on their left wrist, left hip and stated they hit their head. (R3) returned to the community on 6/9/26 (12:45 am) and is using a wheelchair currently due to their hip fracture. Home Health (Physical therapy) was started two weeks ago and resident is doing better. (R3's) care plan was updated to reflect resident needing stand-by assists with ADL's and transfers and increased safety checks. *cont on 809C-1..

NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CITRUS HEIGHTS TERRACE	FACILITY NUMBER: 347001498
	VISIT DATE: 07/01/2026

NARRATIVE

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809C-1.. Resident (R4) was discussed since (R4) previously eloped from the facility on 5/26/2026 and on 4/19/2026. Case management inspections were conducted following each incident. LPA and the RCC observed (R4) to be ambulating in the hallway during the inspection. The RCC stated that (R4) has been "doing good" and recently begun having a 1:1 staff with them during part of the day. The 1:1 goes on walks with (R4), and (R4) has been wearing their WanderGuard band all of the time. RCC confirmed that (R4) enjoys the company of staff.

The RCC stated staff have participated in several recent training sessions on fall prevent and management. Specifically, a non-emergency ambulance provider led training in May 2026, and the monthly facility clinical meeting, in June 2026, addressed falls.

LPA and the RCC toured the interior of the facility and observed residents to be resting and participating in activities with staff. LPA and the RCC observed (R4) to be walking in the hallway with a 1:1 staff.

LPA was advised there were currently (5) caregiver and (2) Med-Tech staff, and (1) concierge present during the inspection. LPA did not observe any health/safety risk or personal rights violation present when touring.

It appears the facility responded to each above incident timely and sent the resident out for further medical attention.

There are no deficiencies issued in this report.

Exit interview. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC809 (FAS) - (06/04)

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