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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700640
Report Date: 04/03/2026
Date Signed: 05/04/2026 05:15:29 PM

Substantiated


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
01/15/2026 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260115093011
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: 53DATE:
04/03/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:L. GuerreroTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff mishandling resident’s medication.
Staff does not safeguard resident’s belongings.
INVESTIGATION FINDINGS:
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 Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA met with Administrator to deliver findings.

Allegation: Staff mishandling resident’s medication. It was reported by S1 that one of R1’s “mounjaro shot” went missing. It was confirmed by interview with R1's daughter(POA) that she provided the facility with a box of mounjaro shots, there were 4 in the box,1 was administered to R1 on 12/26/25 by family. Records confirmed that another shot was administered to R1 on 01/02/26 by the facility, leaving 2 left. The facility was unable to locate the missing medication and requested another shot of the medication from R1's POA. Continued
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
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 5
Control Number 27-AS-20260115093011
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: 04/03/2026
NARRATIVE
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Allegation: Staff does not safeguard resident’s belongings.
A copy of "the facilities' Theft and Loss Policy". LPA did observe this policy included in the resident's admission agreement and it was not completed. The policy indicates, "All new clients will have all property listed on their own inventory list to be signed on move in date. All clients are to report to staff any new item they acquire to be placed on inventory. If an item is loss [lost] or stolen the facility staff will investigate to recover the item. Care home staff will assist resident with filing a police report for any item that is deemed to be lost or stolen if requested." "The resident may decide to not lock up their items at their own risk." Based on interviews and record review, LPA observed that the facility failed to maintain records of accounts of resident's personal property.

The allegations are substantiated.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20260115093011
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2026
Section Cited
CCR
87465(a)(5)
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87465(a)(5) Incidental Medical and Dental Care Services. (a) A plan for incidental medical and dental care shall be developed by each facility.(5)the licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed,
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The citation was cleared today. The facility has completed an in-service for medication administration including this complete regulation 87465
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 LPA reviewed medication administration records and confirmed that the facility was unable to locate the missing medication. This poses a potential health and safety risk to residents in care.
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No further action required
Type B
04/03/2026
Section Cited
CCR
87217(b)
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Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirerment was not met as evidenced by:Observation and records reviewed
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The citation was cleared today. The facility has completed an in-service for medication administration including
residents records and personal rights.
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the facility failed to maintain records of accounts of resident's personal property.
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No further action required
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
01/15/2026 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260115093011

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: 53DATE:
04/03/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:L. GuerreroTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Staff are falsifying resident(s) documents.
INVESTIGATION FINDINGS:
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 Allegation:Staff are falsifying resident(s) documents.
The investigation consisted of records review and interviews with facility staff. LPA reviewed the files of six residents and found no indication that facility staff are falsifying resident documentation. 6 out 6 residents were interviewed to compare resident services to what was written on documentation. LPA found no discrepancies between the care that the residents receive and the resident care plan. Additionally, LPA interviewed 5 facility staff members, all of whom denied the allegations of document falsification. Based on the interviews and evidence gathered during this investigation, LPA was unable to corroborate the allegation.

The allegation is unsubstantiated. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
01/15/2026 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260115093011

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: 53DATE:
04/03/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:L. GuerreroTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility did not have certified administrator.
INVESTIGATION FINDINGS:
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Allegation: Facility did not have certified administrator.
Based on records reviewed the facility has not had a break in service for the current administrator from 6/19/2019 to current. The current and active administrator has been confirmed to have a current certifciation that expires on 6/19/2026.

The department has investigated the complaint allegation and determined that the complaint was UNFOUNDED, A finding of UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis.
Unfounded
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5