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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700235
Report Date: 03/20/2024
Date Signed: 03/20/2024 04:24:48 PM


Document Has Been Signed on 03/20/2024 04:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR:KENT E MULKEYFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:72CENSUS: 54DATE:
03/20/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Carlin RobertsonTIME COMPLETED:
04:30 PM
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On 3/20/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a quarterly health and safety check. LPA Jensen met Carlin Robertson and explained the purpose of today's visit.

LPA Jensen confirmed with the Director of Resident Services that there has not been any infectious condition outbreaks. The facility has recently had a leadership change and Carlin Robertson has been appointed as the new Executive Director. LPA Jensen provided technical assistance related to change in Administrator. Documentation to initiate the Administrator change will be sent by 3/25/24. During the course of an interview, Executive Director Carlin confirmed she spends in excess of 40 hours per a week at the facility.

LPA Jensen reviewed 3 staff files and determined that 3 of 3 staff members have a current first aid certification. LPA Jensen reviewed 3 resident files. LPA Jensen observed 3 of 3 resident files to have current Physician Reports and current Needs and Service Plans. LPA Jensen toured the facility and observed clients engaged in group activities. Freshly baked apple pie was being served for snack. LPA Jensen observed the food supply and determined there was in excess of a 2 day supply of perishable food however there did not appear to be a 7 day supply of non-perishable food. LPA Jensen interviewed the Executive Director who advised that facility is able to transfer food from the Independent Living facility that is adjacent to this facility and under the same management group. Technical assistance was provided with a recommendation to maintain a 7 day food supply on site.

Based on the incident reports received over the last quarter the facility has been meeting reporting requirement timelines. LPA Jensen inspected the medication room and observed multiple systems for documenting when a medication was started. Technical assistance was provided with recommendation to consolidate recording efforts. No deficiencies were issued during the course of this visit. An exit interview was conducted and a copy of this report will be emailed.






SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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