502700444-12-21-2023-27-AS-LRIS-CYRSX8-20231222131528

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700444
Report Date: 12/12/2023
Date Signed: 12/21/2023 05:12:26 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
09/15/2023 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230915131650

FACILITY NAME:	BETHEL ASSISTED LIVING		FACILITY NUMBER:	502700444
ADMINISTRATOR:	MITCHAEL WORD		FACILITY TYPE:	740
ADDRESS:	2325 & 2345 SCENIC DR		TELEPHONE:	(209) 577-1901
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	125	CENSUS: 111	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Mitch Word		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility is not adequately staffed to meet the needs of residents in care

INVESTIGATION FINDINGS:

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On 12/12/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA) Mitch Word, and Facility Designated Representative (FDR), Tim Sidoti and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Current census was 111. A brief interview with FDA Word and FDR Sidoti was conducted.

It was alleged that the facility is not adequately staffed to meet the needs of the residents in care. During the course of investigation, the LPA reviewed facility documents, conducted interviews, and conducted facility visits.LPA conducted 12 staff interviews. 3 out 12 staff members stated that they believed that there is sufficient amount of staff at this time to meet the residents needs. 9 out 12 staff members stated that there was not a sufficient amount of staff to meet the residents needs and feel that they cannot meet the needs of the residents at this time. Based on interviews conducted, it was learned that facility has undergone multiple call-outs throughout the last month that have not been covered or have learned about call outs the time of their shift and are asked to cover the shift while conducting other duties.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230915131650

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: BETHEL ASSISTED LIVING	FACILITY NUMBER: 502700444
	VISIT DATE: 12/12/2023

NARRATIVE

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It was learned that often on NOC shift, there is only one caregiver and one medication technician to assist residents on the Memory Care building which hold approximately 60 residents at a time. Often, they are asked to ask another Medication Technician to come help their building out but will leave only one caregiver on the other side, which approximately holds 50 assisted living residents. It was reported that on some weeks during the AM and PM shift that they will only have 2 caregivers due to call outs. On 11/30/2023, LPA conducted an unannounced facility visit. During this visit, LPA observed 2 medication technicians’ clock in at 5:00am to the memory care building. Prior to the 2 medication technicians clocking there was only 1 medication technician and 1 caregiver. It was learned through that during this shift, 1 medication technician was called in at 2:30am because there was only 1 caregiver on site at the time. In a separate building, LPA observed 1 medication technician who also performed care giving duties for approximately 50 residents.

A review of facility documentation was conducted. LPA reviewed 22 random resident files from the facility. Based on document review, it was observed that 17 out 22 residents were non-ambulatory, and 20 out 22 residents need hands on or one-on-one assistance one of the following items: grooming, bathing, showering, travel to and from meals and activities, and medication management. Upon further document review, it was found that approximately 10 residents need two person assists to help fully assist them to reposition, standing, turning or mobility needs. It was reported by staff that they could not help residents who are two person assists due to helping other residents who need immediate attention. It was stated that staff have resorted turning residents with their bedding and pulling them up from headboard to help alleviate residents needs. Additionally, it was reported that due to the lack of staffing, the residents are having later meals, showers are not being provided as scheduled, and medications are not provided on time and it takes approximately more than 15 minutes to respond to a resident.

Based on the information gathered during the course of this investigation, the facility is not adequately staffed to meet the needs of the residents in care.

Based on observations, review of records and information gathered through interviews, the above allegations were SUBSTANTIATED meaning that there was a preponderance of evidence to prove that the allegations occurred as alleged.

An exit interview was conducted, a copy of the LIC9099, LIC9099-C, 9099-D, and appeals rights was provided to the facility at the end of this visit.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230915131650

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: BETHEL ASSISTED LIVING	FACILITY NUMBER: 502700444
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/13/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.	1 2 3 4 5 6 7	The Licensee agreed to provide LPA Pascua a staffing plan to meet the needs of the residents by the POC date. In addition, the Licensee shall provide a weekly schedule to reflect staffing hours and hours met during the week until 1/31/2024.
	8 9 10 11 12 13 14	This is not met as evidenced by: Based on observation, record review, and interview, the licensee did not ensure that the facility has sufficient staffing to meet the residents needs. LPA conducted 12 staff interviews, 9 out 12 reported that they cannot meet the residents needs. This poses an immediate health, safety, and persons rights risks to persons in care.	8 9 10 11 12 13 14	The facility is activately hiring care staff at this time and will provide a call out plan with a call back up list will be provided
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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.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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