502700444-5-6-2024-27-AS-LRIS-D55T8K-20240510143027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700444
Report Date: 04/23/2024
Date Signed: 05/06/2024 06:27:14 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
12/11/2023 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231211155524

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:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Melissa Orello		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility does not provide residents with adequate food service.
Staff do not follow facility food menu.
Staff do not ensure residents have access to water.

INVESTIGATION FINDINGS:

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On 04/23/2024, 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 deliver complaint findings for the allegations above.

Current census was 101. A brief interview with FDA Orello was conducted.

Allegation: Facility does not provide residents with adequate food service.
It was alleged that the facility does not provide residents with adequate food service. During the course of this investigation LPA conducted interviews, toured the facility, and reviewed facility records. A tour of the facility kitchen was conducted. LPA observed a walk in pantry with non-perishable food supply which included an array of oils, canned fruits, dried goods, and snacks. LPA observed a sufficient amount of non-perishable food supply in both kitchens. LPA observed a walk in refrigerator in which held perishable food supply. LPA observed a sufficient amount of perishable food supply in both kitchens.

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: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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-20231211155524

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: 04/23/2024

NARRATIVE

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In addition, LPA conducted staff and resident interviews. Based on interviews conducted, 6 out 6 staff deny not providing residents with adequate food service. 6 out 6 staff state that they have enough food supply at this time to feed the residents. LPA conducted 9 resident interviews. 3 out 9 residents state that they do not obtain sufficient food service and wish that they would provide different options. 3 out of 9 residents state that they do not get snacks or do not like the snacks provided. 6 out 9 residents deny not obtaining adequate food service. 6 out 9 residents state that they are able to have snacks throughout the day. In addition, LPA reviewed facility records. LPA reviewed the last 6 months of food purchased through US foods. Based on record review it was found that the facility is purchasing food supply for between 111-120 residents monthly. It was found that the facility is spending an average of $294.24 per resident per month. In comparison to the USDA guidelines is between the low-cost to moderately cost food plan per month. Based on information gathered, it is unclear of the facility does not provide residents with adequate food service.

Allegation: Staff do not follow facility food menu.

It was alleged that staff do not follow facility food menu. During the course of this investigation LPA conducted interviews, toured the facility, and reviewed facility records. A review of the facility food menu was conducted prior to a tour of the facility kitchen. A review of the facility menu stated that on 12/12/2023, the facility was to serve the following options for Breakfast lunch and dinner. For breakfast, a choice of cold cereals, cream of wheat, homestyle biscuits and gravy, sausage links, and apricots. For lunch, a Caesar salad, manicotti with marinara sauce, Italian vegetables, garlic bread, tiramisu, seasonal fruit or an alternative lunch entrée of baked fish. For dinner, chef’s choice soup, grilled cheese with cheddar cheese on rye bread, Texas beans, and an apple turnover with powder sugar. LPA observed these items in the facility kitchen. In addition, LPA observed the facility providing the scheduled lunch and it’s alternative to the residents on this day. LPA conducted 9 resident interviews. 9 out 9 residents state that they like the food provided, however would like to have more input on what is served. LPA conducted 6 staff interviews. 6 out 6 staff state that they have food delivered twice a week to ensure that they have the correct food supply to serve the residents. 6 out 6 staff members deny not following the facility food menu. Based on the information gathered, it is unclear of the facility staff did not follow the facility menu.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20231211155524

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: 04/23/2024

NARRATIVE

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Allegation: Staff do not ensure residents have access to water.

It was alleged that staff do not ensure residents have access to water. During the course of this investigation LPA conducted interviews and toured the facility. An interview with 9 residents were conducted. 9 out 9 residents state that they do have access to water. 9 out 9 residents state that they did have individual water bottles, however, the facility has changed to having water that is brought by the staff members to fill out their pitchers. An interview with 6 staff members were conducted. 6 out 6 staff members state that they have implemented a new system where the facility has hydration carts on each floor that includes excess water pitchers and cups. These hydration carts are monitored by staff and are used to fill the residents personal pitcher in their rooms. 6 out 6 staff members deny that they do not provide residents with water. LPA conducted a tour of the facility, where it was observed that the facility does have 3 separate hydration carts available for residents and staff to use throughout the day. Based on the information gathered, it is unclear if the staff do not ensure that residents have access to water.

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: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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