502700235-8-17-2020-27-AS-CACL-BT92CU-20200907171719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 08/17/2020
Date Signed: 08/17/2020 02:52:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/23/2020 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200623152209

FACILITY NAME:	EL RIO MEMORY CARE COMMUNITY		FACILITY NUMBER:	502700235
ADMINISTRATOR:	KEATON, MARY		FACILITY TYPE:	740
ADDRESS:	2828 HEALTHCARE WAY		TELEPHONE:	(209) 543-3805
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	72	CENSUS: 45	DATE:	08/17/2020
		UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Mary Keaton		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff failed to seek medical attention for resident.
Staff denying resident access to personal phone calls.
Facility staff failed to meet resident's hygiene needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Avelina Martinez contacted the facility via telephone to commence a complaint investigation on 8/17/2020 due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the elements of the allegation(s) with Mary Keaton

Throughout the course of the investigation, the Department conducted interviews and reviewed facility documents. Based on the investigation, the following allegations are unsubstantiated:

1. Facility staff failed to seek medical attention for resident.
2.Staff denying resident access to personal phone calls.
3.Facility staff failed to meet resident's hygiene needs.

Continued....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 263-4809
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

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-20200623152209

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: EL RIO MEMORY CARE COMMUNITY	FACILITY NUMBER: 502700235
	VISIT DATE: 08/17/2020

NARRATIVE

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During the investigation, it was learned that Resident 1 (R1) had an telephone appointment with a medical physician on 6/16/2020. It was noted that R1 did not sound distressed on the phone. Furthermore, staff 1 (S1), and witness 1 (W1) conducted phone calls in regards to R1’s change in health and discussed sending R1 to the hospital. S1 also conducted follow up calls with the administrator of this facility in regards to R1's health.

The investigation revealed there was one incontinent incident. Staff 2 (S2) contacted R1's authorized representative and reported the incontinent incident. Furthermore, during this phone call, S2 requested that the authorized representative provide R1 with a supply of incontinent supplies. Additionally, witness 2 (W2) reported during prior health visits there were no major health concerns with R1. W2 reported she did not believe R1 was being neglected at the facility. W2 reported during facility visits, R1 was happy, clean, well fed, well dressed, and sitting in a wheelchair.

Moreover, staff 3 (S3) reported R1 had a flip phone, which at times R1 would forget to charge the flip phone. S3 stated, "there are no times the staff would turn off R1's cell phone." W1 reported that R1 had a cell phone. W1 reported at times R1 had trouble using the cell phone and connecting the call. When this happened, W1 reported making a phone call to the facility. It was also noted that W1 had contact with R1 on 06/15/2020, 06/16/2020, and 06/17/2020. W1 could not recall if phone calls were made directly to R1 or the facility.

Due to the above noted information, although the allegations 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 the allegations are unsubstantiated.

An exit interview was conducted with Mary Keaton a copy of this report was provided to Mary Keaton via email. Mary Keaton signed the report and emailed the report LPA Martinez.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 263-4809
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2020

LIC9099 (FAS) - (06/04)

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