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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700444
Report Date: 03/19/2025
Date Signed: 03/19/2025 04:48:19 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
12/12/2024 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241212131839
FACILITY NAME:BETHEL ASSISTED LIVINGFACILITY NUMBER:
502700444
ADMINISTRATOR:MELISSA ORELLOFACILITY TYPE:
740
ADDRESS:2325 & 2345 SCENIC DRTELEPHONE:
(209) 577-1901
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:125CENSUS: 113DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Melissa Orello TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff filmed resident without consent
INVESTIGATION FINDINGS:
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On 03/18/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility 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 deliver complaint findings for the allegation above.

Current census was 113. A brief interview with FDA Orello was conducted.

It was alleged that that staff filmed a resident without consent. During the course of this investigation, LPA conducted interviews and reviewed facility records. Based on interviews conducted it was learned that sometime in October, R1’s family member visited the facility to check on R1. During this time, R1’s family member witnessed S1 facetiming another staff member with the camera facing the resident and put their phone away.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
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 3
Control Number 27-AS-20241212131839
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: 03/19/2025
NARRATIVE
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S1 admitted that she was facetiming with a former staff member who used care for R1 because they were actively dying. On 12/16/2024, the facility conducted an internal investigation and found that S1 was in fact facetiming while caring for a resident and this staff member was terminated from the facility. A review of R1’s employee counseling form confirms that this staff member violated the resident’s rights by facetiming in the resident’s room. Based on the information gathered the staff member filmed resident without consent.

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.

An exit interview was conducted and copy of this report and appeals rights were provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20241212131839
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: 03/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/18/2025
Section Cited
CCR
80072(a)(1)
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(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons. This is not met as evidenced by:
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The administrator shall provide a statement of acknowledgement and correction shall be provided to the LPA by POC date. In addition, training for no less than 1 Hour shall be provided. Training items, such as items discussed, and staff list shall be provided to the LPA
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This is not met as evidenced by based on interviews and records review, the Licensee did not ensure that staff filmed resident with consent. It was learned that S1 was facetiming R1 with the camera facing the resident as R1’s family walked in. S1 confirmed that they were facetiming another staff member to show R1. This poses a potential health, safety and personal rights risks to persons in care.
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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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3