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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515000683
Report Date: 09/04/2025
Date Signed: 09/04/2025 03:42:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
05/09/2025 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20250509094217
FACILITY NAME:COURTYARD, THEFACILITY NUMBER:
515000683
ADMINISTRATOR:BRANDY STRAHLFACILITY TYPE:
740
ADDRESS:1240 WILLIAMS WAYTELEPHONE:
(530) 790-3050
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:80CENSUS: 56DATE:
09/04/2025
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Brandy StrahlTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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9
Facility staff did not provide adequate supervision to resident in care.
INVESTIGATION FINDINGS:
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13
LPA Hiratsuka, conducted this unannounced complaint visit to deliver the findings into the allegation above.

Title 22 regulations requires facilities to assess a resident to determine the level of care and supervision a resident requires and have a separate written plan of care of how the facility staff are going to meet the resident needs. Title 22 regulations do not require staff to be with a resident, in eye sight of a resident, or within hearing distance of a resident at all times. LPA reviewed facility and hospice medical records. LPA also interviewed staff and witnesses.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
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 3
Control Number 59-AS-20250509094217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COURTYARD, THE
FACILITY NUMBER: 515000683
VISIT DATE: 09/04/2025
NARRATIVE
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The resident records show the caregivers checked on the resident at least every two hours. There was one incident where the resident had a lot of agitation during the late night and early morning hours of the following day. Facility notes show the resident was checked on, but did not show how many times the resident was actually checked because the notes that were written by the staff were summaries of the resident’s condition when it appeared they had time during their shift to do so. The written plan of care stated the resident required frequent checks but did not specify the amount of checks per shift were required.

Due to the information gathered, LPA cannot determine Facility staff did not provide adequate supervision to resident in care. LPA finds allegation to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
05/09/2025 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20250509094217

FACILITY NAME:COURTYARD, THEFACILITY NUMBER:
515000683
ADMINISTRATOR:BRANDY STRAHLFACILITY TYPE:
740
ADDRESS:1240 WILLIAMS WAYTELEPHONE:
(530) 790-3050
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:80CENSUS: 56DATE:
09/04/2025
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Brandy StrahlTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not seek medical attention in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Hiratsuka, conducted this unannounced complaint visit to deliver the findings into the allegation above.

LPA interviewed staff, witnesses, and reviewed hospice medical and facility records. Per the hospice medical records, the facility staff contacted them on a regular basis about changes in the resident’s condition. The records also describe what the staff were seeking assistance with hospice. Facility records show staff did contact hospice but did not go into as much detail as the hospice records, but contact dates match. There was one particular incident where the resident had a lot of agitation and both records show the facility staff spoke to the hospice agency several times and the hospice agency sent a nurse to the facility to evaluate the resident and assist the facility staff with the resident’s care.

“This agency has investigated the complaint alleging; Facility staff did not seek medical attention in a timely manner. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis."
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3