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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001078
Report Date: 09/06/2023
Date Signed: 09/06/2023 11:40:47 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/29/2023 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20230829140445
FACILITY NAME:COURTYARD TERRACEFACILITY NUMBER:
347001078
ADMINISTRATOR:MAGDA LUISFACILITY TYPE:
740
ADDRESS:3408 ALTA ARDEN EXPRESSWAYTELEPHONE:
(916) 486-1281
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:40CENSUS: 39DATE:
09/06/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Amanda RiveraTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not make medications inaccessible to a resident while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/6/23, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to commence a complaint investigation with the allegation above. LPA met with Med Tech Amanda Rivera and explained the purpose of today’s visit. Amanda assisted LPA with today’s visit.

During this visit, LPA Truong toured the facility and conducted interviews with facility staff and residents. Based on the investigation, LPA observed the centrally stored medications area to be locked and inaccessible to residents. Moreover, no medications were observed in any resident rooms. No supporting information to the allegation was discovered. Complaint is deemed to be unfounded at this time.

As a result of this investigation, LPA finds the allegation above to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis.

Exit interview was conducted and a copy of the report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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