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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701206
Report Date: 09/26/2024
Date Signed: 09/30/2024 06:47:53 AM

Document Has Been Signed on 09/30/2024 06:47 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GARDENS OF MODESTO, THEFACILITY NUMBER:
502701206
ADMINISTRATOR/
DIRECTOR:		DOINA S. RADU-APAHIDEANFACILITY TYPE:
740
ADDRESS:2325 ST. PAULS WAYTELEPHONE:
(530) 242-8300
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 73CENSUS: 37DATE:
09/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Stephenie Radu TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 09/26/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Facility Designated Administrator (FDA), Stephenie Radu and explained the purpose of the visit.
Current census was 37. A brief interview with FDA Radu was conducted.
This facility is licensed to served residents who are 60 and over with a capacity of 73. 73 of 73 residents may be deemed non-ambulatory. 10 of 73 may be bedridden. This facility also has a hospice waiver for 16 residents. It was learned that there were a total of 6 residents on hospice, 0 residents who are bedridden, and 3 residents receiving home health services at this time.

LPA reviewed 8 resident files and 5 staff files. All resident and staff files were current and up to date. The Facility Designated Administrator has an active certificate #600701740 and expires on 08/31/2025. LPA reviewed that fire drill log and is in compliance at this time.

A tour of the facility was conducted. This facility has a main building in which has 4 separate wings, Napa, Central Valley, Yosemite and Carmel. Currently, there are no residents residing in Carmel. A separate building, Monterey was also observed and toured. LPA observed a small kitchenette that is equipped with microwave and an addition refrigerator present to cool, heat, and warm up food of the residents if necessary.
All buildings were toured. LPA Pascua toured a bedroom from each wing and observed all furniture and furnishing to be in good repair and in compliance at this time. It was learned that resident bedrooms have been equipped with pull cords were observed.
A review of the resident restrooms was conducted. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. It was learned that this facility has a signal system in resident bathrooms.
LPA Pascua observed a fire extinguisher in Monterey and all wings that were services by Jorgenson Co. on 10/17/2023 and is in compliance at this time.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GARDENS OF MODESTO, THE
FACILITY NUMBER: 502701206
VISIT DATE: 09/26/2024
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Along with the Maintenance director, the LPA tested and observed that smoke detectors and carbon monoxide in rooms and in hallways to be in good repair.
Kitchen area was toured. Facility freezer and refrigerator units were toured. LPA reviewed the food storage supply to make sure that there was always a 2-day perishable and 7-day nonperishable food quantities on site at all times.
Storage area for chemicals and cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Additional incontinent supplies were also identified.
A medication room was identified and tour. Medication carts for all four wings was reviewed and the policies for dispensing, storing, and documentation was discussed with facility staff responsible for the medication management at this time.
First aid kit was observed to be present and contained all of the required components at this time.
A tour of the laundry rooms were conducted. The facility has a total of 3 washers and 3 dryers at this time.
Exterior grounds of this facility was toured. Perimeter fence and gates were observed to be functional and in good repair at this time. Delayed egress and other safety measures were observed to be functional at this time.
The following forms and documents were requested to be updated and submitted into CCL for review by this LPA:
  • LIC 308
  • LIC 400
  • LIC 500
  • LIC 610

A technical violation is being provided today for Section 87312 and was discussed with the Facility Designated Administrator.

Based on the observations made during this visit, no citations are being provided during this visit. An exit interview was conducted and a copy of this report was provided at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
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