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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701206
Report Date: 10/04/2022
Date Signed: 10/05/2022 07:57:38 AM


Document Has Been Signed on 10/05/2022 07:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:GARDENS OF MODESTO, THEFACILITY NUMBER:
502701206
ADMINISTRATOR:PETTAPIECE, THERESAFACILITY TYPE:
740
ADDRESS:2325 ST. PAULS WAYTELEPHONE:
(530) 242-8300
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:73CENSUS: 0DATE:
10/04/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Therest Pettapiece and ResTIME COMPLETED:
04:00 PM
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On 10/04/2022 at 3:00pm an announced office visit was conducted by Regional Manager (RM) Stephenie Doub, Licensing Program Analyst (LPA) Arielle Pascua, and Licensing Program Analyst (LPA) Avelina Martinez. In attendance from The Gardens of Modesto Senior Living, Stanislaus Public Health, California Department of Public Health(CDPH), and California Department of Social Services (DSS) representatives:
  • Cristina Wong: DSS Nurse Evaluator
  • Gorlia Xiong: Medical Investigator for Stanislaus Public Health
  • Payeng Moua: Nurse for Stanislaus Public Health
  • Jon Rosenburg: Physician with CDPH
  • Stantala Ahanya: Infection Preventionist with CDPH
  • Kristy Traush: CDPH
  • Theresa Pettapiece: Executive Director to The Gardens of Modesto Senior Living.
  • Resmika Sharma: Resident Care Director to The Gardens of Modesto Senior Living.

The purpose of this office visit, conducted via Microsoft teams, was to discuss a recent suspected Scabies outbreak at the facility. Some topics of discussed were, pass scabies outbreaks, contact tracing, ensuring staff are using proper PPE, disinfecting, staff monitoring, and visitation.
Per CDPH guidance, the facility will continue to treat residents for rash/scabies outbreak, monitor residents and staff for any rash/scabies symptoms, and report new rash/scabies cases to Local Public Health and CCLD. The parties in attendance and CCLD will conduct another meeting in two weeks to follow up with the facility.
Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited during this visit. An exit interview was conducted with Theresa Pettapiece, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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