347001498-12-4-2025-59-AS-SCAA-DP2RKN-20251204120548

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347001498
Report Date: 12/04/2025
Date Signed: 12/04/2025 12:05:58 PM

Document Has Been Signed on 12/04/2025 12:05 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 TERRACE		FACILITY NUMBER:	347001498
ADMINISTRATOR/ DIRECTOR:	MAGDA LUIS		FACILITY TYPE:	740
ADDRESS:	7952 OLD AUBURN ROAD		TELEPHONE:	(916) 727-4400
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY: 49		CENSUS: 36	DATE:	12/04/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:25 AM
MET WITH:	Rachael Robert, Resident Care Coordinator		TIME VISIT/ INSPECTION COMPLETED:	10:25 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection and met with Rachael Robert, Resident Care Coordinator (RCC). LPA stated the reason for today's inspection was to discuss (2) incident reports recently submitted to the Department. LPA met with Interim Administrator, Magda Luis, at 11:35 am. LPA and RCC discussed resident (R1) who fell in their room on November 21, 2025 (8:35 am). Staff found (R1) sitting on their bed and bleeding from a wound on the upper right side of their forehead that was sustained from a previous fall on October 29, 2025. A Med-Tech contacted (R1's) health care provider around 9:00 am to inform of the bleeding and was advised to apply pressure to control the bleeding. At 9:33 am, the Med-Tech called the health care provider back to advise that the bleeding from the wound was not able to be controlled, and (R1) stated they were feeling light-headed. The facility was advised to send (R1) to the Emergency Room and a medical transport arrived at 10:05 am. (R1) returned to the community later the same day and with no new orders. The RCC stated (R1) has the habit of picking their wound and since this incident, staff have placed a wrap around (R1's) head to deter resident from picking the wound. Staff will also try and redirect (R1) if they are observed to be picking at the wound and they will continue to provide first aid care. The administrator stated (R1's) wound is healing well. LPA and RCC discussed a recent fall for resident (R2) with the hospice nurse who was present. (R2) fell on November 22, 2025 (12:50 pm) out of bed onto the floor and was bleeding from their nose and mouth. Staff immediately contacted the hospice company and was not able to speak to a nurse until 1:30 pm, at which time hospice staff advised that (R2) be sent to the emergency room. Discharge papers show (R2) was treated for a fall and a "comminuted fracture of nasal bone". cont on 809C-1..

NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: 12/04/2025

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809C-1.. The RCC stated that (R2) has been very active lately and staff are monitoring them more. RCC added that (R2) has not been eating lately and hospice is making daily visits. The hospice nurse joined the conversation and confirmed (R2) began receiving hospice services on November 19, 2025 and last ate solids on November 23, 2025, following their last fall. The nurse explained that (R2) is not able to swallow at this time and their medications, Lorazepam and blood pressure have been stopped since they may have been contributing to the falls. The nurse explained that medications for pain have increased and the medication changes seem to be effective as (R2) has not fallen since, and (R2's) vitals remain good.

The nurse and RCC confirmed that (R2) is taking sips of liquid only at this time, and is sometimes is able to take them with a straw. The nurse added that the facility care givers have been providing extra care and more frequent checks to (R2) and staff has also been continually contacting hospice with any questions. The nurse stated that a nurse has visited daily to ensure all medication orders/changes were made effectively.

LPA reminded the RCC and Interim Adminisrator to be sure to submit all incident reports to the department within (7) calendar days of the incident occurring.

It appears the facility took appropriate and timely action in sending each resident out for further medical evaluation.

There are no deficiencies issued in this report.

Exit interview. Copy of report provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

LIC809 (FAS) - (06/04)

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