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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 10/01/2024
Date Signed: 10/01/2024 04:46:19 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
07/22/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240722140824
FACILITY NAME:EL RIO MEMORY CARE COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR:CARLIN ROBERTSONFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:72CENSUS: DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Theresa PettapieceTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident was allowed to remain in dining hall
Staff does not ensure residents are able to have private visits
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/1/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a compliant investigation in to the above listed allegations. LPA Jensen met with Executive Director Theresa Pettapiece and explained the purpose of today's visit.

During the course of the investigation LPA Jensen conducted interviews, conducted site inspections and reviewed records.

Allegation 1: Staff did not ensure resident was allowed to remain in dining hall
It was alleged that there was an occassion wherein a visitor observed staff asking a resident to leave the dining hall before having an opportunity to finish their meal. All parties interviewed stated that residents are afforded the opportunity to finish their meals and in fact offered seconds. It was also learned that the facility has residents that need to be redirected after they finish eating so that staff has an chance to clean the dining hall.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
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 6
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
07/22/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240722140824

FACILITY NAME:EL RIO MEMORY CARE COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR:CARLIN ROBERTSONFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:72CENSUS: DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Theresa PettapieceTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure residents are kept in clean dry clothing at all times
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/1/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegations. LPA Jensen met with Executive Director Theresa Pettapiece and explained the purpose of today's visit.
LPA Jensen intervewed Executive Director Theresa Pettapiece. She confirmed that there was an occasion wherein a resident that requires incontinence care was in a common area with soiled clothing and was observed by a visitor. The facility conducted an investigation and determined that staff had not provided incontinence care in a timely manner because the resident had become combative. Attempts to provide incontinence care were made by multiple staff members however the resident remained consistently aggressive. LPA Jensen reviewed R2's records and the records are consistent with the Executive Director's statement. Based on the interviews conducted and the records reviewed the allegation is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met. Deficiencies are being cited fro the California Code of Regulations (CCR). An exit interview was conducted and a copy of this report proivded.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20240722140824
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: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2024
Section Cited
CCR
87625(b)(3)
1
2
3
4
5
6
7
Managed Incontinence
...the licensee shall be responsible for the following:
Ensuring that incontinent residents are kept clean and dry...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee is currently working with R2's physician and a specialist to properly assess and treat conditions causing the aggressive behavior. A revised incontinence care plan was also nimplemented. No further plan of correction required.
8
9
10
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14
Based on the Executive Director's confirmation that a resident (R2) was in the common area in soiled clothing. This poses a potential risk to the health, safety and personal rights of residents in care.
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9
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14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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 RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
07/22/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240722140824

FACILITY NAME:EL RIO MEMORY CARE COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR:CARLIN ROBERTSONFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:72CENSUS: DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Theresa PettapieceTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure facility is kept in safe clean sanitary conditions for residents in care
Staff do not ensure infection control guidelines are being followed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/1/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegations. LPA Jensen met with Executive Director Theresa Pettapiece and explained the purpose of today's visit.

Allegation 1: Staff does not ensure facility is kept in safe clean sanitary conditions for residents in care
During the course of the investigation, LPA Jensen conducted site visits and inspected the facility on 4 occasions. No unsanitary conditions were observed. LPA Jensen also interviewed a family member, 2 residents and 5 staff members, all of whom felt the facility is maintained in a sanitary condition. Based on LPA Jensen's observations and the interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened, the preponderance of evidence does not prove it.

Continued on LIC 9099C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20240722140824
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: 10/01/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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21
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23
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32
Allegation 2: Staff do not ensure infection control guidelines are being followed
It was alleged that resident 3 (R3) was observed in a common area after being diagnosed with a transmittable skin condition. LPA Jensen reviewed R3's records and determined that R3's skin condition was recognized and treated to the point of no longer needing isolation prior to being observed in the common area. LPA Jensen also reviewed infection control in-service training and verified the training to be up to date. The facility maintains an approved infection control plan. LPA Jensen interviewed 5 staff and all staff interviewed stated that the infection control plan is appropriately followed. Based on the records reviewed and interviews conducted the allegation of "Staff do not ensure infection control guidelines are being followed" is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened, the preponderance of evidence does not prove it .

An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20240722140824
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: 10/01/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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23
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25
26
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31
32
LPA Jensen observed 2 meal services during this investigation and did not observe anything that would be considered a violation of regulation. Based on LPA Jensen's observations and interviews conducted the allegation is UNFOUNDED. A finding of unfounded means the allegation is false, could not have happened, or is without a reasonable basis.

Allegation 2: Staff does not ensure residents are able to have private visits
The facility has a mix of residents with private rooms and shared rooms. The facility also has numerous gathering areas and a large outdoor courtyard. It was alleged that a family member came to visit resident 1 (R1) and was not afforded the opportunity to have a private visit. R1 has a private room. Based on R1 having a private room and the facility having multiple other areas for gathering the allegation is UNFOUNDED. A finding of unfounded means 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 RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6