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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001498
Report Date: 01/30/2024
Date Signed: 01/30/2024 04:15:57 PM


Document Has Been Signed on 01/30/2024 04:15 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:
01/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Toni Jones, Administrator TIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPA) Sabrina Calzada and Melissa Parks arrived unannounced to conduct a case management inspection as a follow up to a meeting the facility had with the Department's Technical Support Program (TSP) on December 12, 2023. LPA's met with Toni Jones, Administrator, and explained the reason for the inspection. On December 12, 2023, five random resident medication records were reviewed and errors were discovered in three of the records, as follows:

Resident (R1) had missed a dosage of anti-psychotic medication, Olanzapine, for days. A Med-Tech staff stated to TSP staff she had been calling (R1's) physician's office for weeks, trying to get the medication refilled. Later during the meeting, it was discovered that the medication had been received by the facility on 12/1/23, but staff did not look in the centrally stored cabinet. The Administrator was advised to complete an incident report and submit to the Department and to notify (R1's) physician immediately. The incident report was received on the same day, 12/12/23 The Medication Administration Record (MAR) for (R1) for December 2023 has staff notations for days from December 1, 2023- December 12, 2023. The Administrator stated that (5) of the days in December were marked that the medication was "absent", so it wasn't given.

The medication, Lorazepam, was listed on resident (R2's) current medication list, but a Med-Tech staff stated this medication had been discontinued on 11/20/23. The discontinuance orders were not able to be found. An updated medication list was printed immediately upon the discovery. The medication Buspar was found in resident (R3's) medication basket, but an order or record of this medication could not be located in resident's files or in the different medication binders. An updated medication list was printed immediately upon the discovery.

Due to these errors being discovered by the Department's Technical Support Program, a Technical Advisory Notes are being issued instead of citations.

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: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
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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