347001498-8-22-2023-59-AS-MSEY-CUZM4B-20230824091628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 08/22/2023
Date Signed: 08/22/2023 05:13:34 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230815101443

FACILITY NAME:	CITRUS HEIGHTS TERRACE		FACILITY NUMBER:	347001498
ADMINISTRATOR:	EDITHA MCCULLOUGH		FACILITY TYPE:	740
ADDRESS:	7952 OLD AUBURN ROAD		TELEPHONE:	(916) 727-4400
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	45	CENSUS: 44	DATE:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Toni Jones, Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff did not prevent resident from wandering from facility
Facility has no Administrator

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open a complaint investigation received anonymously on 8/15/23. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

LPA discussed the allegations with the Administrator, RCC and (1) Med-Tech. The results of the investigation are as follows:

Complaint alleges that a new male resident keeps leaving the building. There is no resident name provided in the anonymous complaint.

All staff interviews revealed that the last time a resident eloped from the facility was on 6/29/23 (7:30 pm), the same day that same resident moved to the community. There have been no additional elopements.

Based on information obtained, LPA finds the allegation to be UNFOUNDED.
cont on 9099C1.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20230815101443

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 08/22/2023

NARRATIVE

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9099C-1.. Facility has no Administrator.
Complaint alleges there is no Administrator overseeing the building.

The facility currently has an appointed Administrator, effective 8/18/23. LPA was informed of the change by email on 8/18/23 and provided with the necessary documentation.

During June and July 2023, the facility had an Interim Administrator. In August and May 2023, the Regional Director and Resident Care Coordinator were covering as Administrator Designee. The Regional Director has an active RCFE Administrator certificate. Prior to May 2023, there was a full-time Administrator in place.

Based on information obtained, LPA finds the allegation to be finding that the complaint is UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis.

Exit interview. Copy of repot provided to the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC9099 (FAS) - (06/04)

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