<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 12/26/2023
Date Signed: 12/26/2023 04:02:48 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
10/11/2023 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20231011111327
FACILITY NAME:EL RIO MEMORY CARE COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR:KENT E MULKEYFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:72CENSUS: 58DATE:
12/26/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kent MulkeyTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure a resident's grooming needs were met
Staff did not properly maintain a resident's room
Staff allowed a resident to have soiled bedding while in care
Staff did not provide adequate supervision to a resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/26/23 at approximately 12pm, Licensing Program Analyst Maja Jensen arrived at facility unannounced to continue an investigation in to the above listed allegations. LPA Jensen met with Executive Director Kent Mulkey and explained the purpose of today's visit. During the course of the investigation, LPA Jensen conducted interviews, met with residents and inspected resident rooms.

Staff did not ensure a resident's grooming needs were met:
LPA Jensen interviewed 8 of 8 staff present on this date. 8 of 8 staff gave consistent accounts of facility procedures for resident grooming which aligned with the admission agreement and regulation. LPA Jensen also interacted with residents during the course of 2 site visits and observed all residents to be adequately groomed therefore the allegation of Staff did not ensure a resident's grooming needs were met is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened, the preponderance of evidence does not prove it.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023
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 5
Control Number 27-AS-20231011111327
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: EL RIO MEMORY CARE COMMUNITY
FACILITY NUMBER: 502700235
VISIT DATE: 12/26/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Staff did not properly maintain a resident's room:
LPA Jensen interviewed 8 of 8 staff members present on this date. 8 of 8 staff gave consistent accounts of facility procedures for maintaining resident rooms which aligned with the admission agreement and regulation. LPA Jensen inspected 5 random resident rooms and observed the beds to be made, trash cans emptied, clean linens and clean bathroom surfaces. Based on the interviews conducted teh allegation of staff did not properly maintain a resident's room is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened, the preponderance of evidence does not prove it.

Staff allowed a resident to have soiled bedding while in care:
LPA Jensen interviewed 8 of 8 staff members present on this date. 8 of 8 staff gave consistent accounts of facility procedures for changing linens which aligned with the admission agreement and regulation. LPA Jensen observed an adequate supply of linens maintained on site to allow for frequent changing of bed sheets. LPA Jensen inspected 5 random resident rooms and observed clean linens in 5 of 5 rooms. Based on the interviews conducted the allegation of staff did not properly maintain a resident's room is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened, the preponderance of evidence does not prove it.

Staff did not provide adequate supervision to a resident
LPA Jensen interviewed 2 facility residents and 8 staff members. LPA Jensen observed staff interacting with residents during the course of 3 site visits. During LPA Jensen's visits on 10/31/23, 12/4/23 and 12/26/23 staff was observed to be attentive and adequately addressing the resident's needs. The 2 residents interviewed stated they are receiving adequate supervision. During the course of interviews with staff LPA Jensen was advised that staff responds to the call system when activated in less than 5 minutes. Based on the interviews conducted and observations made the allegation of Staff did not provide adequate supervision to a resident is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened, the preponderance of evidence does not prove it.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
10/11/2023 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20231011111327

FACILITY NAME:EL RIO MEMORY CARE COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR:KENT E MULKEYFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:72CENSUS: 58DATE:
12/26/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kent MulkeyTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not timely bathe a resident while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/26/23 at approximately 12pm, Licensing Program Analyst Maja Jensen arrived at facility unannounced to continue an investigation in to the above listed allegation. LPA Jensen met with Executive Director Kent Mulkey and explained the purpose of today's visit. During the course of the investigation, LPA Jensen conducted interviews and reviewed records.

Staff did not timely bathe a resident while in care:
LPA Jensen interviewed 8 of 8 staff present during the course of this visit. The staff members consistently stated that residents are given showers at least 2 times per week or more. LPA Jensen reviewed shower logs for Resident 1 (R1) from April 9, 2023 through October 1, 2023 and during this time period there is at least 11 weeks where there is no documentation showing evidence that R1 was showered twice per week. Based on the records reviewed the allegation of Staff did not timely bathe a resident while in care is SUBSTANTIATED. A finding of SUBSTANTIATED means that the preonderance of evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20231011111327
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: EL RIO MEMORY CARE COMMUNITY
FACILITY NUMBER: 502700235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2023
Section Cited
CCR
87464(f)(4)
1
2
3
4
5
6
7
Basic Services
Basic services shall at a minimum include:
...Personal assistance and care as needed by the resident with those activities of daily living such as dressing, eating, bathing. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee or facility staff agrees to submit a plan of actions that will or have been taken to stay in compliance with this regulation.
8
9
10
11
12
13
14
Based on LPA Jensen's record reviews and interviews, the records reviewed were inconsistent with facility policyon showering accordig to staff. This poses a potential risk to the health, safety and personal rights of residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20231011111327
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: EL RIO MEMORY CARE COMMUNITY
FACILITY NUMBER: 502700235
VISIT DATE: 12/26/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Deficiencies are being cited from the California Code of Regulations (CCR) Title 22. Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.

An exit interview was conducted and a copy of this report, a confidential names list and appeal rights were given.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5