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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001498
Report Date: 11/09/2023
Date Signed: 11/09/2023 04:34:58 PM


Document Has Been Signed on 11/09/2023 04:34 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 TERRACEFACILITY NUMBER:
347001498
ADMINISTRATOR:TONI JONESFACILITY TYPE:
740
ADDRESS:7952 OLD AUBURN ROADTELEPHONE:
(916) 727-4400
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:45CENSUS: 44DATE:
11/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Toni Jones, Administrator TIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection following receipt of an incident report. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

LPA and Administrator discussed the incident report submitted on 11/8/23 for a bed bug observed by a NOC shift staff on 11/6/23. After being informed, the Administrator immediately contacted a pest control company who conducted an inspection the same day and confirmed there were bugs in (R1's) bed, specifically in the air mattress delivered by the health care company around the end of September 2023. The pest control company also checked resident (R2's) side of the room and bed, and did not detect any bugs present.

Neither (R1) or (R2) were observed to have any bug bites on them during the past weeks. LPA was provided with a copy of the invoice showing a volumetric heat treatment was performed on 11/7/23 in (R1) and (R2's) room. The invoice states occupants are required to remain outside of the area sprayed for at least (8) hours on the day of the service and a follow up inspection would be conducted. The Administrator stated residents remained out of the room during the treatment process and the health care company was contacted to inform of the situation, as well as local public health to report the bed bugs.

LPA observed the Administrator to call the representative from the pest control company during today's inspection and confirm that a follow-up inspection will be conducted tomorrow, 11/10/23, in the afternoon. Administrator agrees to email documentation of the follow-up inspection.

It appears this was a very isolated incident and the facility acted promptly and effectively upon discovering one bug. There are no deficiencies issued in this report.

Exit interview. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
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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