502700444-4-12-2024-27-AS-LRIS-D4DPQF-20240416113105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700444
Report Date: 04/12/2024
Date Signed: 04/12/2024 01:05:11 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
04/03/2024 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240403154725

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: 101	DATE:	04/12/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Melissa Orello		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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On 04/12/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Melissa Orello and explained the purpose of the visit.
The purpose of this visit was to inform the facility and it's representative that a complaint has been filed against it at this time.
Current census was 101. A brief interview with FDA Orello was conducted.
During the course of this visit LPA conducted a tour of the facility.
LPA toured two facility kitchens. One facility kitchen housed food for Assisted Living Residents. This kitchen had two sinks and a dishwasher that was currently being used and in working condition. LPA conducted a interview with staff who stated they did not have any issues with the dishwasher. A tour of the kitchen in the main building, which houses food for assisted living and independing living residents. This kitchen also had two sinks and a dishwasher that was also currently being used and in working condition. LPA conducted interviews with kitchen staff who stated they did not have any issues with the dishwasher or any items in the kitchen at this time.

Unsubstantiated

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: 04/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024

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-20240403154725

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: 04/12/2024

NARRATIVE

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Based on the information gathered during the course of this visit it is unclear if the facility is in disrepair at this time.
As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024

LIC9099 (FAS) - (06/04)

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