347001498-1-18-2024-59-AS-MSEY-D26PVX-20240205103950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 01/18/2024
Date Signed: 01/18/2024 05:24:34 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
01/02/2024 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240102161217

FACILITY NAME:	CITRUS HEIGHTS TERRACE		FACILITY NUMBER:	347001498
ADMINISTRATOR:	TONI JONES		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:	01/18/2024
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Toni Jones, Administrator		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Facility staff did not provide adequate supervision resulting in resident eloping from facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to continue the complaint investigation for the above allegation. LPA met with Toni Jones, Administrator, and explained the reason for the inspection.

During today's inspection, LPA obtained copies of documents previously requested for resident (R1), including the physicians report, care notes, medication list, MARs and caregiver notes. Documents were not received earlier due to technology issues. LPA also interviewed the Administrator, Resident Care Coordinator, and (3) facility staff.

The results of the investigation are as follows:

cont on 9099C-1..

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: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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-20240102161217

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: 01/18/2024

NARRATIVE

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9099C-1....Facility staff did not provide adequate supervision resulting in resident eloping from facility. The complaint alleges that a family member received a call from staff saying that one of the other residents was able to scale the fence and ended up in the parking lot. There is no day/time mentioned when the call was allegedly received nor a staff person referenced.

Both the Administrator and RCC stated that it is facility protocol to only contact the responsible person(s) or family member(s) that is involved in an incident, and family members for another resident not involved in an incident would not be contacted.

Interviews conducted with facility staff on 1/18/24 did confirm that resident (R1) tried to exit seek a few times in 2023 when living at the facility but was able to be re-directed by staff. Interviews also revealed that (R1) believed a family member was trapped in a car in the parking lot so staff walked her out to the vehicle and showed her that the vehicle did not have any individuals inside.

The Administrator and RCC both confirmed that resident (R2) eloped from the community on/around June 29, 2023 and has not tried to leave unattended again. Staff confirmed this incident was also the last elopement incident for (R2) and no other resident has tried to leave the facility unattended either.

This allegation was also previously investigated for (R2) and found to be substantiated and a citation was issued.

Based on information obtained, this allegation is this complaint report is UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis.

Exit interview. Copy of report emailed to the RCC.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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