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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 09/07/2023
Date Signed: 09/07/2023 12:04:22 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
09/05/2023 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230905164202
FACILITY NAME:CITRUS HEIGHTS TERRACEFACILITY NUMBER:
347001498
ADMINISTRATOR:TONI JONESFACILITY TYPE:
740
ADDRESS:7952 OLD AUBURN ROADTELEPHONE:
(916) 727-4400
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:45CENSUS: 43DATE:
09/07/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Toni Johnson, Administrator TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff do not properly maintain a resident's room while in care
Staff do not ensure a resident has clean bedding
Staff did not keep the facility free from pest
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada and Associate Government Program Analyst (AGPA) Brian Lam arrived unannounced to open and close a complaint received anonymously on 09/05/23. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

LPA discussed the allegations with the Administrator, Activities Director, Maintenance Director, (2) culinary staff, (1) housekeeper and (1) caregiver and toured the interior of the facility, including the common areas, (4) random resident bedrooms and (2) dining rooms, and the staff breakroom.

The results of the investigation are as follows:

Allegation: Staff do not properly maintain a resident's room while in care. The anonymous complaint did not provide a specific resident name or room number and only says a female resident's room and the carpet smell of urine.

LPA conducted a tour of the common areas and resident rooms and did not observe any strong incontinent odors and the carpets were observed to be cleaned recently and are scheduled to be cleaned by an outside company within the next week.

**cont on9099C-1..



Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 59-AS-20230905164202
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: 09/07/2023
NARRATIVE
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9099C-1.. Interviews with the Maintenance Supervisor, housekeeping, caregiver all confirmed individual resident rooms are cleaned regularly, including the bathrooms and carpets/flooring, per the schedule, and every two months, an outside company cleans the flooring in the common areas and in resident rooms as well as all furniture. In addition, caregivers will assist housekeeping by vacuuming or sweeping the flooring in resident rooms.

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

Allegation: Staff do not ensure a resident has clean bedding. The anonymous complaint did not include a specific resident name or room number and only says a female resident's room.

LPA conducted a tour of the common areas and resident rooms, observing beds that were not made, and did not observe any strong incontinent odors or bedding to be soiled. LPA recently toured rooms and checked resident bedding in August on at least (2) occasions and did not observe any soiled linens.

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

Allegation: Staff did not keep the facility free from pests. Allegation reads that the complainant saw a roach in her mother's room. There is no specific name or room number provided or day/time.

A tour was conducted during today's inspection in the kitchen area, laundry area, staff break room and (2) resident dining rooms. LPA also observed underneath the kitchen sinks. In all areas toured, there were no roaches or other bugs observed. Both culinary staff indicated they have not seen any roaches recently in the kitchen. The Activities Director stated she she saw a "gold colored" bug that was "maybe a roach" trying to enter the resident dining room from the outside, this morning. This was an isolated incident. LPA was provided with a recent invoice for service provided on 7/29/23, from an outside pest control company. The Administrator confirmed that the facility receives regular scheduled pest control treatments.

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

Exit interview. Copy of report provided to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2