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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002854
Report Date: 01/06/2025
Date Signed: 01/06/2025 12:36:06 PM

Document Has Been Signed on 01/06/2025 12:36 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:ALMOND GROVE ASSISTED LIVINGFACILITY NUMBER:
345002854
ADMINISTRATOR/
DIRECTOR:		PRICE, DARRELLFACILITY TYPE:
740
ADDRESS:6135 ALMOND AVENUETELEPHONE:
(916) 988-7506
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 78CENSUS: 52DATE:
01/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Assistant Director, Tosha DeviTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 01/06/25 to do case management visit . LPA met with Assistant Director, Tosha Devi and explained the purpose of the visit.

Department followed up on SOC 341 sent by facility on 01/02/25 regarding resident, R1. Facility notified R1s responsible party, law enforcement and Long Term Care Ombudsman (LTCO) regarding this incident. Per facility records, there were no visible injuries to R1 after this incident and R1 was at their baseline.

During today’s visit, LPA interviewed resident, R1 and staff ,S1 regarding this incident. LPA requested documents related to this incident and facility will submit all documents by 01/12/25 by 5pm.

At this time, this case in under review and department will do follow up if warranted.
No citations were issued per Title 22 Regulations.
Exit interview conducted and copy of the report left at facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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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