397004012-9-22-2023-27-AS-KHOS-CW3HTE-20230927062837

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397004012
Report Date: 09/20/2023
Date Signed: 09/22/2023 03:20:29 PM

Unsubstantiated

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
05/30/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230530163220

FACILITY NAME:	RIVER FOUNTAINS OF LODI		FACILITY NUMBER:	397004012
ADMINISTRATOR:	REBECCA COBB		FACILITY TYPE:	740
ADDRESS:	311 WEST TURNER ROAD		TELEPHONE:	(209) 334-3763
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	80	CENSUS: 60	DATE:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Rebecca Cobb, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are verbally and physically abusing residents
Staff does not ensure residents medications are taken once dispensed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced complaint visit at River Fountains of Lodi on 09/20/23 at 8:00 AM to present findings regarding the complaint allegations mentioned above.
In regards to “Staff are verbally and physically abusing residents”, LPA Renee Campbell Interviewed clients R1 to R8. Of the eight residents interviewed, eight of them reported that they had not been showered in cold water by staff. LPA Campbell was also provided with a shower schedule that shows that residents select their preferred shower times. None of the residents interviewed, reported verbal abuse or heard that other residents were abused.

In regards to “Staff does not ensure resident medications are taken once dispensed”, of the eight clients interviewed, seven reported that staff watched them taking medication or remained in the room. All residents reported they took their medication regardless. Residents interviewed also reported that medication is being passed either in the dining room during meals where residents can be observed or in their rooms where staff can confirm meds are consumed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230530163220

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: RIVER FOUNTAINS OF LODI	FACILITY NUMBER: 397004012
	VISIT DATE: 09/20/2023

NARRATIVE

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Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore these allegation are UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 8, no deficiencies cited. Exit interview was held and a copy of report was given to Rebecca Cobb, Administrator.

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

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