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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700640
Report Date: 01/26/2023
Date Signed: 02/07/2023 10:59:29 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
01/18/2023 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230118163105
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: 131DATE:
01/26/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Lizeth GuerreroTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee did not provide resident with an admissions agreement
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Kesha Lewis conducted an unannounced visit to open a 10-day complaint investigation on 1/26/2023. LPA met with Administrator Lizeth Gurerro , Jennifer Almendarez Director of resident care and Jennifer Cumby office manager and explained the purpose of the visit to investigate the allegations: Licensee did not provide resident with an admissions agreement.

LPA requested copies of R1'S admissions agreement, facility provided two (2) admissions agreements one from 2020 when R1 was in assisted living and one from 2021 when R1 moved to independent living.

LPA attempted to interview R1 but R1 had left the facility with family and when R1 returned before LPA could conduct an interview R1 had fallen asleep.

Continued on 9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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 2
Control Number 27-AS-20230118163105
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: COURTYARD AT RIO LAS PALMAS, THE
FACILITY NUMBER: 392700640
VISIT DATE: 01/26/2023
NARRATIVE
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The department has investigated the complaint allegations. We have found 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.

Exit interview conducted with facility administrator and a copy of report will be emailed to facility as LPA'S printer is not working at this time.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2