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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 09/26/2022
Date Signed: 09/27/2022 11:26:33 AM

Unsubstantiated


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
08/15/2022 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 27-AS-20220815142727
FACILITY NAME:EL RIO MEMORY CARE COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR:KEATON, MARYFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:72CENSUS: 71DATE:
09/26/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Mary KeatonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility has bed bugs
Unqualified staff giving insulin to residents
Unqualified staff doing wound care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit to the facility September 26, 2022 at 10:30 a.m. to deliver findings on the above allegations. LPA Hurt met with facility Administrator Mary Keaton and explained the purpose of the visit.

Regarding the allegation Facility has bed bugs. Based on interviews and records reviewed the facility does not currently have any resident rooms with active bed bugs. The facility did previously have rooms with bed bugs beginning in March 2022. Administrator Mary Keaton provided records documenting the local exterminator has been to the facility several times to inspect, and spray or heat treat different rooms. Administrator Mary Keaton stated the local exterminator would come out same day to confirm if there was actually bed bugs. Administrator Mary Keaton stated as soon as the resident rooms were confirmed to have bed bugs the staff would remove the resident from the room along with all clothing, and bedding to wash in high heat.

Continued on 9099C. ..

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
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
Control Number 27-AS-20220815142727
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: 09/26/2022
NARRATIVE
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...Continued from 9099

Administrator Mary Keaton stated the exterminator would then treat the room as they felt necessary. Administrator Mary Keaton stated the exterminator came on September 13, 2022 and looked in all residents rooms, and resident common areas to confirm there is no bed bugs in the facility. Administrator Mary Keaton is following normal procedure when bed bugs are discovered in a facility. therefore this complaint is UNSUBSTANTIATED. A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

Regarding the allegation Unqualified staff giving insulin to residents. Based on LPA interviews and records reviewed unqualified staff is not giving insulin to residents. LPA reviewed facility Medication Administration Records documenting facility nurses signatures for all insulin given to residents. LPA interviewed 6 facility staff who all stated they have never witnessed anyone besides facility nurses giving insulin to residents, therefore this complaint is UNSUBSTANTIATED. A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

Regarding the allegation unqualified staff doing wound care. Based on LPA interviews conducted, and records reviewed the facility does not have unqualified staff doing wound care. LPA Hurt interviewed 6 facility staff who all stated facility nurses, home health, or hospice are the only staff providing wound care. Staff 1 stated they work nights and were trained never to do any type of wound care on residents. Staff 1 stated they were trained they are to document any resident needing wound care, notify the nurses, home health, or hospice to assist the resident. LPA Hurt reviewed records documenting home health nurses detailed care notes for wound care on Resident 1, and also for Resident 2. therefore this complaint is UNSUBSTANTIATED. A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

No deficiencies were cited today per Title 22 Regulations.



Exit interview conducted with Administrator Mary Keaton and a copy of this report along with appeals rights left at the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2