392700640-7-7-2021-27-AS-KHOS-C4WJEP-20210714065929

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700640
Report Date: 07/07/2021
Date Signed: 07/07/2021 03:04:38 PM

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
05/07/2021 and conducted by Evaluator Ashley Boothe

COMPLAINT CONTROL NUMBER: 27-AS-20210507154212

FACILITY NAME:	COURTYARD AT RIO LAS PALMAS, THE		FACILITY NUMBER:	392700640
ADMINISTRATOR:	GUERRERO, LIZETH		FACILITY TYPE:	740
ADDRESS:	877 EAST MARCH LANE		TELEPHONE:	(209) 957-4711
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	80	CENSUS: 63	DATE:	07/07/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Lizeth Gurerro		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not meet residents needs
Staff did not give resident a copy of admissions agreement
Staff did not itemized a list of fees on the admissions agreement
Staff are overcharging resident
Staff is threatening resident

INVESTIGATION FINDINGS:

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On 07/7/2021 at 8:45am, Licensing Program Analyst (LPA) Ashley Boothe spoke with Administrator Lizeth Gurrero regarding facility risk assessment questions who confirmed no staff or clients have experienced symptoms within the last 10 days. At 9:45am, LPA arrived unannounced to deliver the findings of complaint investigation with the following allegations: Staff did not meet residents needs, staff did not give resident a copy of admissions agreement, staff did not itemized a list of fees on the admissions agreement
staff are overcharging resident, and staff is threatening resident. LPA was allowed entry to the facility.

During the course of the investigation LPA reviewed records, conducted on site inspection and conducted interviews. LPA observed admissions agreement signed by Resident one (R1) at the time of move in to include all fees and services listed as charged on R1's monthly bill. Interviews concluded R1 was given a copy of the signed admission's agreement at the time of signing and additional copies were provided to R1 at R1's request.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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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Control Number 27-AS-20210507154212

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: COURTYARD AT RIO LAS PALMAS, THE	FACILITY NUMBER: 392700640
	VISIT DATE: 07/07/2021

NARRATIVE

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Continued from 809 C.

LPA reviewed R1's monthly billing statement addressed to R1 detailed credits and debits itemized to account for ongoing outstanding balance due forward, current fees, concessions of reduced rates, changes in level of care, payments received, and automatic payments not processed. Administrator stated they have gone over the bills with R1 multiple times as the system is complicated but all credits and debits match the charges due to the facility. R2's level of care changes requested by R1 created multiple debits and credits on the same billing statement. LPA observed the bill was challenging to understand but reviewed all charges to be accurate as credits and debits balance with the total of monthly charges and payments received as recorded on balance forward, most current statement, and the rates in the admission's agreement. Three Notices of Outstanding Balance due addressed to R1 and R2 were delivered with instructions for immediate payment, instructions for disputing balance, and final notice of previous attempts to collet a debt and request to make payment in full. No eviction notices were sent. LPA observed R1 paid overdue balance in full prior to today's date after final notice was delivered. Currently R1 has a credit for overpayment on most recent billing statement due for credits for R1 and Resident two (R2) moving.

R2's required assistance with bathing and medications. LPA reviewed case notes no missed assistance with showering or medications documented. Interviews concluded R2 needs were meet according to R2's care plan and staff were staffed to provide the appropriate level of care. R2's level of care was changed at R1's request.

It was determined in the course of the investigation based on the information provided through documentation and interview, the aforementioned allegations are unfounded. This agency has investigated the complaint alleging staff did not meet residents needs, staff did not give resident a copy of admissions agreement, staff did not itemized a list of fees on the admissions agreement, staff are overcharging resident, and staff is threatening resident. and we have found the allegations false.

Per the California Code of Regulations, Title 22, Division 8, no deficiencies observed or cited. Exit interview held, copy of report given.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC9099 (FAS) - (06/04)

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