392700640-1-9-2023-27-AS-MJEN-CMX2CZ-20230109161733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392700640
Report Date: 01/09/2023
Date Signed: 01/09/2023 04:17:53 PM

Document Has Been Signed on 01/09/2023 04:17 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

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:	01/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Lizette Guerrero		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/9/22 at approximately 10:20am, Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual visit. LPA Jensen met with Executive Director Lizette Guerrero and explained the purpose of today's visit. The structure is 3 story building that accommodates both independent and assisted living. This annual visit focuses on the assisted living community. LPA Jensen toured the facility including the grounds and interior. The community is gated and access is controlled. There is a large green space for activities and benches throughout. There is a centrally located pond on the grounds which is also gated and was observed to be locked. LPA Jensen toured the inside of the inside of the facility including but not limited entrance hall, resident rooms, offices, medication room, activities room, dining hall, kitchen, laundry room and movie room. The facility was observed to have all required signs posted including but not limited to contact information for the Long Term Care Ombudsman, Resident Personal Rights, Resident Council, Family Council, See Something-Say Something and Employee Rights. The temperature in facility ranged between 72 degrees and 76 degrees which falls within the required range of 68-85 degrees. The facility was observed to be sanitary and free of odor with all furnishings and flooring in good repair. The Ansul system was last serviced in September of 2022 and is in compliance. The fire extinguishers were last serviced in September of 2022 and is in compliance. The facility keeps adequate emergency supplies and first aid supplies on hand. All staff encountered where determined to be fingerprint cleared and associated to the facility. The resident rooms were adequately furnished and contained night stands, dressers, chair and adequate lighting. The water temperature in the resident rooms was measured at 118 degrees which falls within the required regulatory range of 105-120 degrees. There are 3 alert signals installed in each room that are in good working order. Continued on LIC 809C....

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/09/2023

NARRATIVE

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Continued from LIC 809...
There was extensive activities posted available for the residents including bingo, walking clubs, Friday Happy hour, art classes, puzzles, movie night and a variety of outings. LPA Jensen observed a fitness gym and art auditorium with equipment and furnishings and supplies all in good repair. The laundry room was observed to have a lock and appliances in good working order.

LPA Jensen toured the kitchen and observed a two day supply of perishable food and a 7 day supply of non-perishable food. The kitchen was observed to be sanitary. A menu was posted in a prominent location for view by the residents and the offerings were consistent with what was being prepared. The refrigerators were observed to be set a temperature of 36 which falls within the required range for preserving food safety. There was no expired food observed. Chemicals and toxins were observed to be kept locked and away from any food products.

The medications were observed to be kept in a separate locked room. The medication room was observed to be organized. There were 2 locked medication carts observed with narcotics being double locked. Narcotic medication for Resident 2 (R2) was counted in the presence of Executive Director Lizette Guerrero and staff 1 and the supply of medication was consistent with the records maintained. LPA Jensen reviewed Medication Administration Records (MARs) for R2 and determined that PRN medication effectiveness is being consistently documented. LPA Jensen reviewed 3 resident files and determined them to be in compliance.

The facility was found to be in substantial compliance and no deficiencies are being issued as a result of this annual visit.

An exit interview was conducted and a copy of this report was given.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

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