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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700963
Report Date: 12/11/2024
Date Signed: 12/11/2024 02:02:55 PM

Document Has Been Signed on 12/11/2024 02:02 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:OARS AT GREENBACK LANE, THEFACILITY NUMBER:
342700963
ADMINISTRATOR/
DIRECTOR:		CHRISTAL ANDERSONFACILITY TYPE:
740
ADDRESS:6550 GREENBACK LANETELEPHONE:
(916) 212-0388
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 57CENSUS: 52DATE:
12/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH: Executive Director- Christal AndersonTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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On 12/11/24 Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to conduct a case management visit regarding a Death report that the department received on 12/05/24. LPAs met with Executive Director (ED) Christal Anderson and explained the purpose of the visit.

The purpose of the visit is to gather more information regarding a death report Community Care Licensing (CCL) received on 12/05/24. LPAs spoke with the ED regarding the events leading up to R1s death. Death report states that the immediate cause of death is still pending. ED is awaiting Coroners report and will send LPAs a copy once received.

LPAs obtained a copy of R1's LIC602, ID page, and hospice notes.

At this time, no deficiencies are cited.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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