502700235-2-9-2021-27-AS-KHOS-BY5NXE-20210211095102

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 02/08/2021
Date Signed: 02/09/2021 01:24:54 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
07/03/2020 and conducted by Evaluator Anthony Tuck

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200703093020

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: 49	DATE:	02/08/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Mary Keaton		TIME COMPLETED:	01:23 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal items.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anthony Tuck contacted facility via telephone call and spoke with Executive Director (ED) Mary Keaton on this day to conclude a complaint investigation and to deliver the complaint findings due to COVD-19 precautionary measures.

During the investigation LPA conducted an interview with the responsible party (RP) and two staff interviews. LPA received, reviewed copy of clients LIC 602. During the investigation, it was learned that the ipad and glasses were both found on 07/03/2020 and during an interview with ED that the Ipad was never lost but was placed in a secure drawer by facility staff.

Continued on LIC 9099c...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (209) 242-5200
LICENSING EVALUATOR NAME: Anthony Tuck	TELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2021

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-20200703093020

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: 02/08/2021

NARRATIVE

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Based on interviews, and documentation reviewed from the facility, the Department (CCLD) has found the
allegation of the facility not safeguarding the resident’s personal items Unfounded. A finding that the
complaint allegation(s) is UNFOUNDED meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.
An exit interview was conducted with Executive Director Mary Keaton via telephone and a copy of 9099, 9099-C's, Appeal Rights, and 811(Confidential Names) was provided to Mary via email, an electronic email read receipt confirms receiving these documents. Administrator will sign 9099, 9099-C's and send back electronic email to LPA.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (209) 242-5200
LICENSING EVALUATOR NAME: Anthony Tuck	TELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2021

LIC9099 (FAS) - (06/04)

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