347001498-9-18-2025-59-AS-SCAA-DLMQ89-20250918115623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347001498
Report Date: 09/18/2025
Date Signed: 09/18/2025 11:56:39 AM

Document Has Been Signed on 09/18/2025 11:56 AM - 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:	VERONICA MORALES		FACILITY TYPE:	740
ADDRESS:	7952 OLD AUBURN ROAD		TELEPHONE:	(916) 727-4400
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY: 49		CENSUS: 42	DATE:	09/18/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Veronica Morales, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

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 and Licensing Program Manager (LPM) Maribeth Senty arrived unannounced to conduct a case management inspection and met with Veronica Morales, Administrator, stating the reason for today's inspection. LPA, LPM and the Administrator discussed the following residents/reports submitted to the Department: Resident (R1's) change in condition that occurred on/around 7/25/25 was discussed. Resident's care plan was updated then to reflect (R1's) refusal of care. During today's inspection, (R1's) medical professional was contacted by phone and explained recent steps taken due to (R1) starting with them, including medication management and changes. It was agreed that the facility will issue a 30-day notice to (R1) and responsible person/s since (R1) continues to refuse essential care. The Administrator agreed to provide a copy of the 30-day notice to the Department for review within (5) days of its issuance. Resident (R2) passed on September 9, 2025 at the facility and was under Palliative/end of life care. (R2) had several falls starting in August 2025 and was sent to the hospital on 8/13/2025 after suffering a stroke while attending their health care center. (R2) returned on August 14,2025 and palliative care was started. The Administrator contacted the Med-Tech staff who observed (R2) who had fallen out of bed on 9/9/25. This staff explained what position (R2) was found in and provided a photograph during the discussion. (R2's) head was between a pillow and the mattress and was not stuck in the bed rails as the facility earlier reported. The facility will submit an incident report for the incident on 9/8/25 since non-emergency medical technicians responded after the fall and assisted (R2) back into bed. *cont 809C-1..

NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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)

Page: 2 of 3

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: 09/18/2025

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
26
27
28
29
30
31
32

809C-1.. Resident (R3) was allegedly hit by staff (S1) on 9/6/25 (5:00 pm) when in the dining room. This event was reported to the Administrator by a non-staff person who described (R3) as having an aggressive behavior prior to (S1) hitting (R2) back on the left shoulder. An internal investigation was conducted
and it was determined that (S1) was not observed by other staff to strike (R3). Additionally, the Ombudsman investigated the alleged abuse and spoke with (R3) who stated they were not struck, which was consistent with what the facility determined.

LPA was provided with a copy of the SOC341 during today's inspection that showed the report was faxed successfully on 9/15/25 (11:32 am). LPA reminded the Administrator that incident reports are due within (7) days of the incident to the Department.

It was agreed that due to not having sufficient evidence, (S1) would be able to return to work. Additionally, (S1) has worked at the community for a couple of years and there have been no prior concerns/complaints. (S1) will be assigned to another side of the building upon return. Additionally, cameras may be placed in the dining rooms.

The facility appears to have followed facility protocols for working with the resident in trying to provide care, seeking timely medical assistance and placing a staff on administrative leave when an internal investigation is warranted.

A tour was also conducted of the interior. There are no deficiencies issued in this report.

Exit interview. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

LIC809 (FAS) - (06/04)

Page: 3 of 3