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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700012
Report Date: 01/31/2025
Date Signed: 01/31/2025 01:33:08 PM

Document Has Been Signed on 01/31/2025 01:33 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:TWIN RIVERS AT NATOMASFACILITY NUMBER:
342700012
ADMINISTRATOR/
DIRECTOR:		GENAYA REESEFACILITY TYPE:
740
ADDRESS:421 SAN JUAN ROADTELEPHONE:
(916) 216-3058
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 48CENSUS: 37DATE:
01/31/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Rosa LesuiTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On January 31, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a case management visit regarding an incident report the Department received. LPA met with med-tech and explained the purpose of the visit.

Additionally, LPA spoke with Administrator on the phone to inform Administrator of LPA's purpose.

Incident report revealed that on January 23, 2025, S1 observed S2 asking R1 who is the current president, how many pills did R1 take. When R1 responded "I don't know", it was observed that S2 responded "you don't know anything, you have dementia."

LPA and Administrator discussed the following incident. Administrator stated when it was reported to the Administrative Office, S2 has then been removed from the schedule and no longer works at the facility. Administrator stated the incident was self reported and corrective actions were taken immediately.

As a result of the reported behavior of S2, deficiencies was cited. LPA explained that although facility took appropriate actions, since the incident did occurred at the facility, it was a violation against personal rights.

Exit interview and a copy of report and appeal rights provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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Document Has Been Signed on 01/31/2025 01:33 PM - It Cannot Be Edited


Created By: Cassie Yang On 01/31/2025 at 01:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TWIN RIVERS AT NATOMAS
FACILITY NUMBER: 342700012

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
87468.1(a)

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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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S2 is no longer working at the facility.

Licensee is to conduct an Elder Abuse training for all staff. Proof of training along with name of attendees are due to LPA Yang via fax or email by February 28, 2025.
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Based on file review, Licensee did not comply as R1 was not treated with dignity and respect by S2 which poses a potential risk for residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Anthony Perez
LICENSING EVALUATOR NAME:Cassie Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2025


LIC809 (FAS) - (06/04)
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