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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 08/21/2025
Date Signed: 08/21/2025 04:41:24 PM

Substantiated


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
04/24/2025 and conducted by Evaluator Ellen Lindstrom
COMPLAINT CONTROL NUMBER: 27-AS-20250424151715
FACILITY NAME:EL RIO MEMORY CARE COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR:THERESA PETTAPIECEFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:72CENSUS: DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Theresa Pettapiece, AdministrastorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Facility did not ensure that staff receive CPR/First Aid training
INVESTIGATION FINDINGS:
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On 07/24/2025, LIcensing Program Analyst (LPA) Triel Ellen LIndstrom and Licensing Program Manager (LPM) Lisa Rios arrived unannounced to the facility to deliver complaint findings for the allegation that facility did not ensure that staff receive CPR/First Aid training. The LPA and LPM met with Reshmika Sharma, Director of Resident Services, explained the purpose of the visit, and conducted an interview.

Allegation: Facility did not ensure that staff receive CPR/First Aid training

On 4/28/2025, LPA Arielle Pascua visited the facility and requested an employee roster and a copy of all current staff’s CPR/First Aid training on file. LPA Lindstrom reviewed this proof of training. She determined that all Med Techs and Licensing Vocational Nurses have valid training, but that only five of twenty-four Resident Assistants have valid CPR/First Aid training.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Ellen Lindstrom
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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 2
Control Number 27-AS-20250424151715
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: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2025
Section Cited
CCR
87411(c)(1)
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Personnel Requirements: (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training.. (1) Staff providing care shall receive appropriate training in first aid…
This requirement is not met:
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The facility will change their FIrst Aid policy to show that anyone providing assistance with activities of daily living will be required to be First Aid trained by a qualified professional.
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Based on review of the facility policy, only one staff on premises is required to receive 1st aid training. This poses a potential risk to the health, safety, or personal rights of persons in care.
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Within thirty days, staff will attend First Aid training and the Administrator will submit both a sign-in sheet from that training and a copy of First Aid certificates for all staff who assist residents with activities of daily living. These items shall be submitted to LPA Lindstrom at ellen.lindstrom@dss.gov.ca.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Ellen Lindstrom
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2