502700235-2-14-2023-27-AS-KHOS-CPFP7N-20230227100413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 02/14/2023
Date Signed: 02/14/2023 03:10:43 PM

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
02/09/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230209081012

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: 60	DATE:	02/14/2023
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Mary Keaton		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not following COVID-19 guidelines.

INVESTIGATION FINDINGS:

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On 2-14-23 at 12:55pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate the complaint allegation noted above. LPA met with Administrator Mary Keaton and explained the purpose of the visit. During this investigation, LPA conducted interviews with Resident1 (R1), R2, and R3. LPA also conducted interviews with Administrator, Staff1(S1), S2, and S3. Additionally, LPA conducted facility observation including common areas, resident rooms, dining areas, and activity areas as well as caregiver stations. Based on interviews and observations, it was determined that facility is currently following COVID-19 precautions. LPA observed all staff to be wearing masks, and promoting social distancing as necessary. Additionally, LPA observed hand washing stations, appropriate availability of hand sanitizers, availability of additional masks, gowns, and other personal protective equipment (PPE) located in facility's storage areas and other areas available for staff, visitors, and residents in care. LPA also observed sign in and sign out procedures at the front desk including wall thermometer to measure visitor temperatures upon entry. Interviews conducted revealed facility does not currently have active COVID-19 and precautions were followed appropriately during times of previous active COVID cases. {Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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-20230209081012

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: 02/14/2023

NARRATIVE

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Based on the interviews and observation conducted, there is not a preponderance of evidence to conclude that facility is not following COVID-19 guidelines currently or in the past. As a result, this allegation is UNSUBSTANTIATED. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur.

An exit interview was held with Mary Keaton and a copy of this report was left with Mary. Appeal Rights provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

LIC9099 (FAS) - (06/04)

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