502700235-9-19-2024-27-AS-LRIS-D9GQ9X-20240926115903

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 09/19/2024
Date Signed: 09/19/2024 05:17:58 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
06/25/2024 and conducted by Evaluator Maja Jensen

COMPLAINT CONTROL NUMBER: 27-AS-20240625164056

FACILITY NAME:	EL RIO MEMORY CARE COMMUNITY		FACILITY NUMBER:	502700235
ADMINISTRATOR:	CARLIN ROBERTSON		FACILITY TYPE:	740
ADDRESS:	2828 HEALTHCARE WAY		TELEPHONE:	(209) 543-3805
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	72	CENSUS: 61	DATE:	09/19/2024
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Theresa Pettapiece		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not properly trained.
Staff are not meeting resident's hygiene needs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Maja Jensen arrived on 9/19/24 for an unannounced visit to deliver findings for complaint investigation received on June 25, 2024. LPA Jensen met with Executive Director Theresa Pettapiece and explained the purpose of the visit.
Allegation 1: Staff are not properly trained
During the course of this investigation, LPA Jensen conducted an interview with a staff member responsible for providing care to residents. During the course of this interview, the staff member advised LPA Jensen that they are responsible for providing care for a resident with pressure injuries and received no specialized training from the facility or an external agency on how to provide care specific to this client and the restrcited health condition. The staff member also advised that they received no training from the facility or an external agency specific to the use a hoyer lift despite the fact that the facility is home to a resident that requires it's use. Based on the interview conducted the allegation of "Staff are not properly trained is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met

Substantiated

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: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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 3

Control Number 27-AS-20240625164056

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: 09/19/2024

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

Allegation 2: Staff are not meeting resident's hygiene needs.
On 8/19/24 Licensing Program Analyst (LPA) toured the facility and observed resident 1 (R1) with a brief that was falling out of her pant leg. R1 advised LPA Jensen that she need assistance using the restroom so LPA Jensen pulled the call signal cord. After several minutes no staff members came to assist and LPA Jensen escorted the resident to the restroom and provided stand by assistance. On this same day LPA Jensen observed 2 residents wearing shirts soiled with food, several residents with no shoes and 1 resident that was walking around barefoot. Based on LPA Jensen's observations while touring the facility the allegation of "Staff are not meeting resident's hygiene needs" is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met.

Deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6.

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: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240625164056

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: 09/19/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/20/2024 Section Cited CCR 87611(c)	1 2 3 4 5 6 7	Prior to accepting or retaining a resident with an allowable health condition as specified in Section 87618...facility staff shall have knowledge and the ability to recognize and respond to problems...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Licensee agrees to send an attestation that all staff providing care for residents will be trained on providing care specific to the residents individual health conditions.
	8 9 10 11 12 13 14	Based on LPA Jensen's interview, the staff member provided care for a resident with a wound and a resident with a hoyer lift but received no specialized training on the wound care or equipment use. This poses an immediate risk to the health, safety and personal rights of residents in care.	8 9 10 11 12 13 14
Type B 10/10/2024 Section Cited CCR 87464	1 2 3 4 5 6 7	Basic Services Basic services shall at a minimum include: ...Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to conduct training on personal grooming and to implement measures to document and ensure assistance with grooming occurs.
	8 9 10 11 12 13 14	Based on LPA Jensen's observation multiple residents were observed to be in need of assistance with grooming. This poses a potential risk to the safety and personal rights of residents in care.	8 9 10 11 12 13 14

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 Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3