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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507002509
Report Date: 06/16/2025
Date Signed: 06/18/2025 02:26:10 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
01/28/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250128085931
FACILITY NAME:STRATFORD AT BEYER PARK, THEFACILITY NUMBER:
507002509
ADMINISTRATOR:RODRIGUEZ, NICOLE EFACILITY TYPE:
740
ADDRESS:3529 FOREST GLENN DRTELEPHONE:
(209) 236-1900
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:107CENSUS: 80DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nicole Rodriguez TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not dispense medication to resident as prescribed.
INVESTIGATION FINDINGS:
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On 06/16/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA was met by Facility Designated Administrator (FDA), Nicole Rodriguez and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Current census was 80. A brief interview with FDA Rodriguez was conducted.

Allegation: Staff did not dispense medication to resident as prescribed.
It was alleged that staff failed to administer medication to a resident (R1) as prescribed. During the investigation, the Licensing Program Analyst (LPA) conducted staff interviews and reviewed facility records. According to staff interviews, on January 26, 2025, R1 contacted the facility to report they would be late in returning for their scheduled medication. Upon R1’s return, facility staff declined to administer the medication, citing that more than one hour had passed since the scheduled time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
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 6
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
01/28/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250128085931

FACILITY NAME:STRATFORD AT BEYER PARK, THEFACILITY NUMBER:
507002509
ADMINISTRATOR:RODRIGUEZ, NICOLE EFACILITY TYPE:
740
ADDRESS:3529 FOREST GLENN DRTELEPHONE:
(209) 236-1900
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:107CENSUS: 80DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nicole Rodriguez TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's personal belongings.
Facility is not following resident's care plan
INVESTIGATION FINDINGS:
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On 06/04/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA was met by Facility Designated Administrator (FDA), Nicole Rodriguez and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.
Current census was 80. A brief interview with FDA Rodriguez was conducted.
Allegation: Staff did not safeguard resident’s personal belongings
It was alleged that staff did not safeguard resident’s personal belongings. During the course of this investigation, LPA conducted interviews and reviewed facility records. Based on interviews conducted with staff, it was denied that they did not safeguard the resident’s personal belongings. An interview with 5 residents were conducted. 5 out 5 residents deny that they belongings are not safeguarded and do not have any issues at this time. Based on the information gathered, there is not sufficient evidence to provide that the staff did not safeguard resident’s personal belongings.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20250128085931
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: STRATFORD AT BEYER PARK, THE
FACILITY NUMBER: 507002509
VISIT DATE: 06/16/2025
NARRATIVE
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Based on the information gathered, staff did not administer the medication to the resident as prescribed.

Based on observations, review of records and information gathered through interviews, the above allegations were SUBSTANTIATED meaning that there was a preponderance of evidence to prove that the allegations occurred as alleged. The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulation.

An exit interview was conducted, a copy of this report and appeals rights were provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20250128085931
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: STRATFORD AT BEYER PARK, THE
FACILITY NUMBER: 507002509
VISIT DATE: 06/16/2025
NARRATIVE
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Allegation: Staff is not following resident’s care plan.

It was alleged that staff are not following resident’s care plan. During the course of this investigation, LPA conducted interviews and reviewed facility records. Based on staff interviews conducted it was denied that staff do not follow resident’s care plans. It was stated by 5 staff that they conduct staff meetings regarding updates with all residents. In addition, care plans are reviewed on an as needed basis. An interview with 5 residents was conducted, 5 out 5 residents deny that they are not receiving care and supervision. Based on the information gathered, there is not sufficient evidence to prove that staff are not following resident’s care plan.

As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20250128085931
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: STRATFORD AT BEYER PARK, THE
FACILITY NUMBER: 507002509
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2025
Section Cited
CCR
87465(a)(4)
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The licensee shall assist residents with self-administered medications as needed.
This is not met as evidenced by: Based on record review and interview, the licensee did not ensure that R1 was provide medication as prescribed.
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The facility provide a statement of correction and acknowledgement to the LPA by the POC Date.
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 It was learned that R1 was out of the facility and requested their medication at the time of return however was not provided the medication. This poses a potential health, safety, and personal rights risks to persons in care.
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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: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20250128085931
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: STRATFORD AT BEYER PARK, THE
FACILITY NUMBER: 507002509
VISIT DATE: 06/16/2025
NARRATIVE
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Based on the information gathered, staff did not administer the medication to the resident as prescribed.

Based on observations, review of records and information gathered through interviews, the above allegations were SUBSTANTIATED meaning that there was a preponderance of evidence to prove that the allegations occurred as alleged. The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulation.

An exit interview was conducted, a copy of this report and appeals rights were provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6