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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701277
Report Date: 01/02/2025
Date Signed: 01/03/2025 08:01:14 AM

Document Has Been Signed on 01/03/2025 08:01 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:RIVERETTE RESIDENCEFACILITY NUMBER:
502701277
ADMINISTRATOR/
DIRECTOR:		CATHERINE TORREZFACILITY TYPE:
735
ADDRESS:1409 RIVERETTE DRIVETELEPHONE:
(209) 531-6694
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 4CENSUS: 4DATE:
01/02/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Danyell Williams, CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 12/30/24, the licensee, Jaeveen Sandhu called LPA Campbell regarding resident 1 (R1). He requested guidance on what he should do for the client. Per the facility log, R1's mother signed R1 out on 12/30/24 at 5 pm and signed them in at 7 pm. Per staff, R1’s mother later stated that R1 was drunk and that they threw up in the driveway of the facility. She also stated that R1 had eaten, something R1 later disputed. Per the licensee, R1 was asked if they needed to go to the hospital and they said no.

On 01/02/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility regarding a case management for a resident who returned to the facility intoxicated after a visit with their mother. LPA Campbell met with Danyell Williams, Caregiver and explained the purpose of the visit. Upon entry, LPA Campbell observed a living room with a couch, minimal décor, a dining room table and TV. The facility was clear of debris and pathways were free of obstacles.

R1 later came out of his room and greeted LPA Campbell with a wave. LPA Campbell returned the greeting and asked how they were and if they felt well. R1 smiled, gave a thumbs up and continued to the kitchen where the asked S1 to see their mother. Due to R1’s diagnosed Selective Mutism, LPA Campbell chose not to further interview them. S1 later stated that at this time, R1’s mother had to call the licensee to arrange for R1 and S1 to spend time together for two reasons. In the past, R1 had lied to staff and their mother about their mother agreeing to pick him up and because R1 returned to the facility intoxicated.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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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: RIVERETTE RESIDENCE
FACILITY NUMBER: 502701277
VISIT DATE: 01/02/2025
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LPA Campbell expressed concern to the licensee about possible addiction issues due to past requests for alcohol from R1 to staff. LPA Campbell attempted to contact the residents Service Coordinator but they were out of the office until the January 6th due to the holidays and no substitute with VMRC could be reached. LPA Campbell also attempted to reach out to 2 staff who were present during the 12/30/24 incident. One staff person could be reached. S2 described R1 as tilting sideways with lowered “sleepy” eyelids after getting out of their mother's car. A review of R1’s IPP shows that R1 is in an adult foster program but R1's mother communicates with R1 by phone and spends time with them intermittently.

No deficiencies are being cited. R1 obtained and used alcohol and possible marijuana while off facility grounds while in the care of his mother. When staff saw that R1 was ill, they followed procedure and attempted to provide medical care to R1 which they refused. Staff continued to monitor R1 when they returned home. The licensee will arrange to consult with the service coordinator, R1’s Social Worker and possibly R1’s psychiatrist in regards to possible updates to R1’s IPP concerning R1’s mother and alcohol use.

A Copy of this report was left with the Caregiver Danyell Williams.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC809 (FAS) - (06/04)
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