502700235-12-26-2023-27-AS-KHOS-CZRLBK-20240123073649

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 12/26/2023
Date Signed: 12/26/2023 02:55:07 PM

Unfounded

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
10/26/2023 and conducted by Evaluator Maja Jensen

COMPLAINT CONTROL NUMBER: 27-AS-20231026091826

FACILITY NAME:	EL RIO MEMORY CARE COMMUNITY		FACILITY NUMBER:	502700235
ADMINISTRATOR:	KENT E MULKEY		FACILITY TYPE:	740
ADDRESS:	2828 HEALTHCARE WAY		TELEPHONE:	(209) 543-3805
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	72	CENSUS: 58	DATE:	12/26/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kent Mulkey		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident being charged for unagreed services.

INVESTIGATION FINDINGS:

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On 12/26/23 at approximately 10am Licensing Program Analyst (LPA) 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 reviewed the resident file for Resident 1 (R1) and the admission agreement for R1. LPA Jensen also interviewed the Executive Director and the Director of Resident Services.

The admission agreement specifies services that are included in the monthly rate as follows:
-24 hour supervision
-Laundry, room cleaning
-Meals
-Activities

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (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)

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Control Number 27-AS-20231026091826

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

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The admission agreement also specifies items that are not included as follows:
-Medication
-Transportation
-Briefs for incontinence care
-Nutritional Supplements
-Personal Toiletries
-Health Care Provider Fees
-Beauty Salon Services

LPA Jensen interviewed the Resident Care Director who advised that typically residents are asked to use Pharmarica for prescription medication as this is the pharmacy that the facility contracts with however someone can request using a different pharmacy if the family brings the medication in or it is mailed directly to the facility. The Resident Care Director indicated that upon admission, the responsible party is asked to sign a consent form for using Pharmarica. LPA Jensen reviewed a consent form signed by the responsible party for R1 for using Pharmarica or Kaiser.

LPA Jensen also interviewed 8 of 8 staff members present on this date. All staff members gave consistent accounts of the services provided to residents which aligns with the admission agreement and regulation.

As a result of the records reviewed, interviews conducted and LPA observation, the allegation of resident being charged for unagreed services is UNFOUNDED. A finding of UNFOUNDED means that the allegation is false, could not have happened or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (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)

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