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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700640
Report Date: 04/11/2024
Date Signed: 04/11/2024 03:27:11 PM


Document Has Been Signed on 04/11/2024 03:27 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:COURTYARD AT RIO LAS PALMAS, THEFACILITY NUMBER:
392700640
ADMINISTRATOR:GUERRERO, LIZETHFACILITY TYPE:
740
ADDRESS:877 EAST MARCH LANETELEPHONE:
(209) 957-4711
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:80CENSUS: 61DATE:
04/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:56 PM
MET WITH:L. GuerreroTIME COMPLETED:
03:15 PM
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On 4/11/2024, LPA Johnson arrived and met with the Administrator, who assisted LPA with the visit to determine if the plan of correction has been completed for the citation given on 1/31/2024.

LPA reviewed the information regarding the temporary generator installation,
Plans have been submitted and approved for express review. The installation plan for the city of Stockton will be done next Wednesday, April 17 @ 8am. The facility should have the permit next Wednesday to install the temporary generator.

The second plan of correction date has passed (4/9/2024). LPA observed that the non-working generator has not been removed and the fire extinguisher in the area is outdated 9/9/2022. The other extinguisher throughout the facility were current with the date of 9/9/2023 as the service date (Advisory given)

The facility will submit a plan to the department when the temporary generator will be in place by the close of business on 4/11/2024. This is an extension of the plan for the 4/09/2024.

The facility will be assessed civil penalties if the plan of correction is not completed or a plan submitted by close of business today 4/11/2024. Exit interview conducted
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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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