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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700444
Report Date: 12/12/2023
Date Signed: 01/23/2024 08:39:43 AM

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
12/04/2023 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231204084247
FACILITY NAME:BETHEL ASSISTED LIVINGFACILITY NUMBER:
502700444
ADMINISTRATOR:MITCHAEL WORDFACILITY TYPE:
740
ADDRESS:2325 & 2345 SCENIC DRTELEPHONE:
(209) 577-1901
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:125CENSUS: 111DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mitch Word TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee does not ensure facility has sufficient staffing to meet the care needs of residents
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 the licensee does not ensure that the facility has sufficient staffing to meet the care needs of residents. 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.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: (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)
Page: 1 of 2
Control Number 27-AS-20231204084247
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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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.It was learned that often on NOC shift, there is only one caregiver and one med tech 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 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.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. This allegation is substantiated however no licensing citation will be given for this allegation. This allegation was cited on a complaint report on 12/12/2023. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: (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)
Page: 2 of 2