502700235-12-5-2024-27-AS-MJEN-DBP244-20241205160319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 502700235
Report Date: 12/05/2024
Date Signed: 12/05/2024 04:03:50 PM

Document Has Been Signed on 12/05/2024 04:03 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 COMMUNITY		FACILITY NUMBER:	502700235
ADMINISTRATOR/ DIRECTOR:	THERESA PETTAPIECE		FACILITY TYPE:	740
ADDRESS:	2828 HEALTHCARE WAY		TELEPHONE:	(209) 543-3805
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY: 72	TOTAL ENROLLED CHILDREN: 0	CENSUS: 53	DATE:	12/05/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Theresa Pettapiece		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

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	On 12 5/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required one year annual visit. LPA Jensen met with Executive Director (ED) Theresa Pettapiece and explained the purpose of today's visit. LPA Jensen toured the grounds and observed all paths to be free of obstruction. There are two enclosed areas with outdoor furniture and shaded areas for client enjoyment. The facility has raised garden beds that residents can maintain. A delayed egress system is in place. LPA Jensen toured the interior of the facility. The facility has a lobby seating area upon entry that is adjacent to a conference room used for family care conferences, training and other administrative needs. The resident rooms and common areas are configured in a number 8 formation to encourage residents to walk and easily find their way back to their rooms. The facility staffs with nurses, medication technicians, care providers and there is a wound specialist is available as well. There are currently 10 hospice residents and the facility has a hospice waiver for 15. The nurses station is centrally located with several arm chairs directly outside the station and this area has become a a popular gathering junction for residents. There are also multiple "club rooms" where residents can congregate and watch movies or do activities or meet with family. LPA Jensen inspected multiple occupied living units and found them to be sanitary and adequately furnished. LPA Jensen also inspected the staff room, management offices and laundry room. The laundry room is locked and inaccessible to residents in care. The facility has a machine that attaches labels to clothing and every piece of clothing, including socks are labeled with the resident's name and room number. Adequate linens were observed to allow for frequent bedding changes. The thermostat was set at 74 degrees for the comfort of the residents. LPA Jensen inspected the bathrooms. There are grab bars available. The bathroom water temperature in a common area was determined to be within the required range. Continued on LIC 809C...

Lisa Rios	TELEPHONE: (916) 969-9685
Maja Jensen	TELEPHONE: (916) 639-5584
	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/05/2024

NARRATIVE

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LPA Jensen inspected the kitchen and observed it to be sanitary. The refrigerator and freezer temperatures were within the required range. No expired food was observed. Food was labeled with dates. There was 2 days of perishable food and 7 days of non-perishable food available. A snack consisting of french toast and fruit was being served. An enchilada casserole and vegetables were served for lunch. Kitchen equipment that was not in use was covered with plastic. The Ansul system was last serviced in September of 2024 and is in compliance. Documents were posted in the kitchen displaying all residents with special diets, changes to diets and the corresponding resident photo.

Numerous activities were on the schedule for this day including sing-a-long, musical balloon games, relaxation manicures, abstract art class, sunshine club and daily chronicles. Several big events are scheduled this month for the holiday including "Santa Paws" wherein therapy dogs visit residents.

The smoke detectors and carbon monoxide detectors are hard wired and in working order. The facility maintains first aid kits that are complete. No toxins or medications were observed to be accessible to residents in care. The facility sketches were posted throughout with exit routes clearly marked and the facility sketch accurately reflects the layout of the facility. All garbage cans were observed to have tight fitting lids. The facility liability insurance is current and compliant. The fire extinguishers are in compliance. Monthly disaster drills are conducted and logged.

LPA Jensen reviewed the marketing materials and no issues were observed. LPA Jensen reviewed 6 staff files and determined them to be complete and in compliance. LPA Jensen obtained a copy of the current LIC 500. LPA Jensen interviewed residents during the course of this inspection who all advised they are satisfied with the care they receive, the activities and the food service. LPA Jensen interviewed staff, all of whom were able to answer questions sufficiently.

Technical assistance was provided in the areas of medication management for new admissions and maintaining an odor free facility.

No deficiencies were observed. An exit interview was conducted and a copy of this report provided.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC809 (FAS) - (06/04)

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