<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515000683
Report Date: 03/23/2023
Date Signed: 03/23/2023 02:58:18 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, 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
01/09/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20230109160715
FACILITY NAME:COURTYARD, THEFACILITY NUMBER:
515000683
ADMINISTRATOR:PICKARD, CAROLFACILITY TYPE:
740
ADDRESS:1240 WILLIAMS WAYTELEPHONE:
(530) 790-3050
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:80CENSUS: 57DATE:
03/23/2023
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Brandy StrahlTIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused a resident to fall while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Hiratsuka, conducted this unnanounced complaint visit to deliver the findings of the allegation above.

LPA interviewed staff and the resident in question. LPA also reviewed the incident report and resident's file. Resident stated the facility staff put an onxygen tank in the middle of the floor and the resident tripped on it. The staff stated they found the resident in the bathroom on floor with no oxygen tank around.

LPA cannot prove or disprove the allegation because each side has their own version of events.

Due to the information gathered, LPA cannot determine the Staff caused a resident to fall while 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
01/09/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20230109160715

FACILITY NAME:COURTYARD, THEFACILITY NUMBER:
515000683
ADMINISTRATOR:PICKARD, CAROLFACILITY TYPE:
740
ADDRESS:1240 WILLIAMS WAYTELEPHONE:
(530) 790-3050
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:80CENSUS: 57DATE:
03/23/2023
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Brandy StrahlTIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have backup emergency services for the residents
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 and a resident. LPA reviewed facility policies for emergencies. This investigation was because the facility lost power due to the weather in the beginning of January 2023. Title 22 regulations and the CA Health and Safety Codes do not require facilities to have generators. They do require facilities to have plans in place. This facility does have a written plan for emergencies. Resident who require oxygen are switched from concentrators to tanks if there is no electricity. The staff make more rounds to ensure residents are okay. There are plans for meals and other necessities.

“This agency has investigated the complaint alleging; Facility does not have backup emergency services for the residents. 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:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
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 2