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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001498
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:48:48 PM


Document Has Been Signed on 11/16/2023 03:48 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: DATE:
11/16/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Toni Jones, Administrator, Robert Godfrey, Regional Director, Adina Nitu, Quality ASsurance Coordinator, and Mark Cimino, Licensee TIME COMPLETED:
01:35 PM
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An informal conference was conducted at 1:00 pm on November 16, 2023, with Sacramento North Regional Office via Microsoft Teams. Present in the meeting was Licensing Program Manager (LPM) Maribeth Senty, Licensing Program Analyst (LPA) Sabrina Calzada, Licensee, Mark Cimino, Regional Director, Robert Godfrey, Quality Assurance Coordinator, Adina Nitu, and Administrator,Toni Jones.

The purpose of this informal conference meeting is to address the facility’s compliance issues and substantiated allegations surrounding the numerous complaints received since May 2023. Specifically, the Department has concerns stemming from repeated violations following citations being issued.

The licensee was told that this Informal conference is a part of the Administrative Action process and that further citations may result in an elevation to a formal non-compliance conference, which could lead to a referral to the Department's legal division for possible revocation of license.

The following topics were covered during today's meeting:

· Numerous complaints since May 2023- and the facility’s insight.


· Substantiated allegations.
· Repeated Substantiated allegations.
· Steps taken to increase compliance- staffing changes, medication audits, facility processes, enrollment in the Department’s Technical Support Program (TSP)
· Importance of training new staff.

In an effort to support the facility in maintaining substantial compliance with the Health and Safety Statute and the Title 22 regulations, the Department is developing a plan with the licensee to address causes for concerns.
cont on 809-C-1...
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
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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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: 11/16/2023
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809C-1..

Licensee agreed to do the following:

· Continue to conduct regular in-service training in response to any current areas of concern at the facility and with various medication topics.
· Continue to conduct medication audits- both internally and externally and to follow audit recommendations.
· Participate fully in the Department’s TSP engagement- focus areas: medication documentation and organization.
· Ensure there are always adequate staffing levels to meet residents’ care needs and to increase staffing when appropriate, such as with an increase in census.
· Submit any outstanding Plan of Corrections (i.e. October, November)

No deficiencies were cited during today’s meeting.

An copy of this report was provided via email to the Administrator with a request to return a signed copy to Community Care Licensing by COB 11/16/23.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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