392700640-5-29-2024-27-AS-KHOS-D5XKK5-20240605075744

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700640
Report Date: 05/23/2024
Date Signed: 05/29/2024 03:17:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2024 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240412131625

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: 59	DATE:	05/23/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	L. Guerrero		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff speaks inappropriately to residents in care
Facility staff forces residents to take medications.
Facility staff left residents in soiled clothing.
Staff are not according privacy to residents in care

INVESTIGATION FINDINGS:

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On ,5/23/2024 LPA Johnson arrived unannounced to deliver findings. LPA was met by Administrator.

Allegation: Staff speak inappropriately to residents in care.
It was alleged that staff speak inappropriately to residents in care. During the course of this investigation, the LPA conducted 5 staff and 5 resident interviews. 5 staff interviews were conducted. 5 out of 5 staff members denied that they speak inappropriately to the residents in care. 5 out of 5 staff members stated that they have not heard any other staff members speak inappropriately to residents in care.

Continued

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 27-AS-20240412131625

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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, THE	FACILITY NUMBER: 392700640
	VISIT DATE: 05/23/2024

NARRATIVE

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3 out 5 staff members stated that they do not believe that other staff members speak inappropriately but may show other actions against the residents. 2 out of 5 residents denied that any staff speak inappropriately to them. 3 out of 5 residents denied hearing any inappropriately comments towards other residents. 3 out 5 residents were unable to complete interviews because of medical reasons. Based on interviews conducted, it was unclear if staff spoke inappropriately to residents in care. Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED

Allegation: Facility staff forces residents to take medications. LPA Johnson interviewed five staff members (S1-S5) and ED. All five staff members and ED denied that any staff had forced Residents to take medications. ED said the facility’s protocol is to give reminders if a resident does not want to take their medications. LPA Johnson interviewed additional residents. They said staff do not force us to take any medications. LPA Johnson notes that some resident have histories of refusing medications and making false allegations about staff members and others. LPA Johnson reviewed medication administration records (MARs). MARs showed that some residents had refused medications on several The department has determined the following as it relates to the allegation that a resident was forced to take medications. Based on interviews and record review, the above allegation is UNSUBSTANTIATED

Allegation: Facility staff left residents in soiled clothing. LPA interviewed three residents who all denied being left in soiled clothing. Staff interviewed denied residents were or have been left in soiled clothing. Other witnesses interviewed reported hearing that residents were left in soiled clothes, they have not witnessed it themselves, but they heard from other staff. Based on the information provided through interviews, the allegation that staff leave residents in soiled clothing was UNSUBSTANTIATED.

Continued

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240412131625

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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, THE	FACILITY NUMBER: 392700640
	VISIT DATE: 05/23/2024

NARRATIVE

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Allegation: Staff are not according privacy to residents in care. Based on interviews with staff, and residents in care. Residents interviewed stated that they only get injections in the dining area at their requested and always in the medical room or their own room. Staff interviewed stated that they have never witnessed resident in care getting injections or taking medication in the dining area. Staff stated that medication are given in the med-room or the residents room. Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

LIC9099 (FAS) - (06/04)

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