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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001498
Report Date: 04/22/2026
Date Signed: 04/22/2026 12:17:05 PM

Document Has Been Signed on 04/22/2026 12:17 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 TERRACEFACILITY NUMBER:
347001498
ADMINISTRATOR/
DIRECTOR:		MAGDA LUISFACILITY TYPE:
740
ADDRESS:7952 OLD AUBURN ROADTELEPHONE:
(916) 727-4400
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 49CENSUS: 48DATE:
04/22/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Rachael Robert, Resident Care CoordinatorTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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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 of the inspection. LPA and RCC discussed the following (2) recent incident reports submitted to the Department.

Resident (R1) left the facility unassisted on April 19, 2026 (5:05 pm) by exiting through the back gate. (R1) was brought back by a nearby neighbor approximately (20) minutes later. The RCC stated staff present during the incident have been held accountable due to not following all protocols when an alarm is activated. The RCC stated the protocols are that staff is to look at the monitor which shows interior/exterior camera footage, communicate with other staff by radio, and allow the alarm to run until the resident is located. The RCC explained that a staff was leaving at the time the alarm was activated, but the alarm was immediately shut off which caused some staff to think (R1) had already been located. A follow up in-service staff training was held on April 21, 2026 to address the miscommunication error and not following proper protocols. In addition, (1) staff received a disciplinary action on April 20, 2026.

LPA and the RCC toured the building and observed/tested multiple exit doors. The RCC demonstrated how to properly ensure the egress door is locked, after being activated, including waiting a few seconds for the door to close/lock and staff possibly needing to enter a code before walking away from the exit door. The RCC stated daily radio checks are completed and proper protocols are discussed in daily Stand-up meetings with staff. LPA reviewed (R1's) physician's report which notes (R1) is not able to leave the facility unsupervised due to their primary diagnosis. The RCC stated (R1) likes to walk around inside the community and outside as well, and the new staff was not familiar with (R1's) behavior due to being off work for an extended period due to personal reasons. *cont on 809C-1..
NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2026
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: 04/22/2026
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809C-1. LPA and the RCC discussed resident (R2) who had an unwitnessed fall on April 12, 2026 (4:00 pm) after slipping on the floor in their resident bathroom. (R2) requested to go to the Emergency Room due to complaints of back pain and a leaking colostomy bag. (R2) returned the same day with a new colostomy bag and continued to receive Home Health services, which include Physical Therapy. (R2) continues to receive checks (4x/shift) and staff will promptly report any changes in condition to the primary care physician.
The RCC stated (R2) was sent out to the hospital on April 19, 2026, due to an issue related to the colostomy bag and is scheduled to return to the community later today, possibly with a bed alarm. The facility promptly sent (R2) out for further medical treatment after communicating with Home Health.

Per California Code of Regulations Title 22, Division 6, Chapter 8, the following (1) deficiency is being cited related to resident (R1), on the 809-D page.

Exit interview. Copy of report and appeal rights provided.
NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/22/2026 12:17 PM - It Cannot Be Edited


Created By: Sabrina Calzada On 04/22/2026 at 11:41 AM
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: CITRUS HEIGHTS TERRACE
FACILITY NUMBER: 347001498

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/22/2026
Section Cited
CCR
87705(f)(6)

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87705 Care of Persons with Dementia
(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements: (6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents. This requirement is not met as evidenced by:
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Staff training on Delayed Egress Doors and the Wander Guard System was conducted by the RCC on April 21, 2026. LPA obtained a copy of the training agenda/attendees.
Additionally, daily radio checks are completed as well as reminders during stand-up (9:15 am) and at cross over meetings (3:00 pm).
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Based on documentation reviewed and an interview conducted, the Licensee did not ensure that resident (R1) was not able to exit the facility, unassisted, on 4/19/2026 (5:05 pm approximatey), which posed an immediate health and safety risk to residents in care. Resident was returned to the facility, uninjured, 20 minutes later, at approximately 5:25 pm.
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The facility will obtain an updated Physician's Report to accurately reflect (R1) being at risk for elopement and unsafe wandering. (R1) initially wore a Wander Guard bracelet on their wrist until/around February 17, 2026, when it was replaced with a Wander Guard anklet. (Consent form on file- signed by (R1) and their responsible person). *THERE IS NO FURTHER ACTION NEEDED- POC CLEARED ON APRIL 22, 2026. *

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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.
Lauren Crocker
NAME OF LICENSING PROGRAM MANAGER:
Sabrina Calzada
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2026


LIC809 (FAS) - (06/04)
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