397004012-8-13-2024-27-AS-KHOS-D8HSJ4-20240826135432

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397004012
Report Date: 08/13/2024
Date Signed: 08/13/2024 03:19:13 PM

Unsubstantiated

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
06/26/2024 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20240626103042

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: 64	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Rebecca Cobb		TIME COMPLETED:	03:32 PM

ALLEGATION(S):

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Staff mismanaged residents’ medication
Staff did not ensure that the facility was kept clean
Staff threatened residents with eviction
Staff did not provide a safe and comfortable environment for residents

INVESTIGATION FINDINGS:

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On 8/13/2024 at 12:31pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the allegations noted above. LPA met with Administrator Rebecca Cobb and explained the purpose of the visit. During this investigation, LPA conducted interviews with five staff members and three residents in care. Additionally, LPA conducted record reviews of medication log sheets, staffing schedule, and housekeeping schedule. LPA also conducted a facility observation on 07/10/2024 and 08/13/2024. .

Allegation: Staff mismanaged residents’ medication. LPA conducted interviews, observations, and record reviews as noted above. Based on evidence reviewed, it was determined that facility is currently maintaining medication storage adequately including the use of locking mechanisms and inaccessibility to residents in care. It was further revealed through record reviews and interviews that facility has provided prescribed medications to residents in care consistently and adequately. Interviews conducted did not reveal any corroborated statements of mismanaged medication. {Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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 27-AS-20240626103042

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: RIVER FOUNTAINS OF LODI	FACILITY NUMBER: 397004012
	VISIT DATE: 08/13/2024

NARRATIVE

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As a result, there is no preponderance of evidence to conclude that staff has or is currently mismanaging residents’ medication, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Allegation: Staff did not ensure that the facility was kept clean. LPA conducted interviews and record reviews as noted above. Based on observation, LPA determined that facility is maintaining a clean environment for residents including no malodorous occurrences or excessive stains on walls or floors in common areas and kitchen. An observation of various resident rooms determined a clean and sanitary environment. Interviews and record reviews revealed an adequate cleaning schedule in place necessary to meet the housekeeping needs of the facility. As a result, there is not a preponderance of evidence to conclude facility has not maintained cleanliness, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Allegation: Staff threatened residents with eviction. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that there is currently no resident under consideration for eviction. Additionally, interviews conducted revealed no corroborated statements of facility staff using verbalization in a threatening manner to suggest evictions for any reason. As a result, there is not a preponderance of evidence to conclude staff threatened residents with eviction, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Allegation: Staff did not provide a safe and comfortable environment for residents. LPA conducted observation and interviews as noted above. LPA’s observations revealed facility is currently meeting the standard of a safe and comfortable environment for residents. LPA observed facility to maintain an adequate temperature throughout facility and within regulatory guidelines. Observations also revealed doors, bathroom fixtures, lighting, and furnishings within common areas and resident bedrooms to be functioning adequately. LPA observed facility’s designated smoking area to contain table and chairs used by residents to be within 20-25 feet or more of facilities entrance. {Cont. on 9099C}

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240626103042

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: RIVER FOUNTAINS OF LODI	FACILITY NUMBER: 397004012
	VISIT DATE: 08/13/2024

NARRATIVE

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A door leading to the smoking area was observed to be shut during LPA’s observation. Interviews conducted did not reveal any corroborated statements of facility not maintaining a safe and comfortable environment. As a result, there is not a preponderance of evidence to conclude staff is not providing a safe and comfortable environment for residents, therefore this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Rebecca Cobb and a copy of this report was provided to Rebecca. Appeal rights provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

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