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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 11/21/2024
Date Signed: 11/21/2024 12:38:44 PM

Unsubstantiated


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
08/14/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240814122522
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:
11/21/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility did not assess residents prior to admission.
Staff does not meet resident’s dietary needs.
INVESTIGATION FINDINGS:
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On 11/21/24 LPA Jensen arrived at facility 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.

During the course of this investigation LPA Jensen interviewed 2 former staff members, 7 current staff members, a resident family member, and 2 current residents. LPA Jensen also reviewed resident records and facility policy records.

Allegation 1: Facility did not assess residents prior to admission
Facility staff, with the exception of management, consistently indicated that while residents were assessed prior to admission, the assessments were often incomplete therefore the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that 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: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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 2
Control Number 27-AS-20240814122522
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: 11/21/2024
NARRATIVE
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 LPA Jensen provided technical assistance on the importance of providing a thorough and complete assesment prior to admission. The Executive Director informed LPA Jensen that new policies are being implemented effective 12/1/24 which include an admission checklist to assist in this process. LPA Jensen reviewed the policy which includes a procedure for ensuring all preadmission documentation is complete and in the resident's record.

Allegation 2: Staff does not meet resident’s dietary needs.
LPA Jensen conducted interviews with staff, residents and a family member. None of the parties interviewed stated that staff failed to meet resident dietary needs. Kitchen staff interviewed indicated that they would benefit from additional training regarding renal diets but there was no evidence that an inappropriate diet was served to a resident in care and as such the allegation is UNSUBSTANTIATED. Technical assistance was provided on the benefit of nutritional education specific to elderly care. The Executive Director confirmed that a Culinary Director has been hired and that a meal attendance tracking system is being implemented to provide another layer of monitoring.

No deficiencies were cited. An exit interview was conducted. A copy of this report and appeal rights were provided.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2