River Fountains of Lodi

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 11/13/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Rebecca Cobb, who was briefly interviewed at this time. Current census was 61 residents. It was learned that there were (3) residents under the care of hospice at this time and this facility does have a waiver to be able to accept and retain up to 10 hospice residents at any given time. It was learned that there were (5) residents receiving services through home health as well. It was learned that there (11) residents diagnosed with dementia at this time. This facility does not have an approved fire clearance to be able to accept and retain any bedridden residents at this time. A tour of this facility was conducted. Administrator certificate was observed to be present for facility designated Administrator Rebecca Cobb with certificate # 7005597740 set to expire on 07/12/2026 and found in compliance at this time. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication room located near the front office was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated medication technicians at this time. The medication carts were observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restroom was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility laundry area, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 06/12/2025 by the local fire extinguisher company, Fire Master, and in compliance at this time. First aid kits were observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter, side gates, and exits was conducted. A review of (7) facility resident files was conducted and noted on the following LIC 858. A review of (7) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 13, 2025

Type of visit: Case Management - Incident

Unannounced case management visit conducted out at this facility on 11/13/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Rebecca Cobb who was briefly interviewed at this time. Also present was the Resident Care Director Michelle Rodriguez. Current census was 61 residents. The purpose of this case management visit was to discuss the Unusual Incident Reports (UIRs) that were submitted into CCL for the time frame of 10/01/2025 to 11/02/2025. These UIRs were submitted into CCL for a total of (4) residents at that time. This LPA was present to discuss the background behind the incidents, follow-up by this facility and it's staff, and updated care plan related to each individual resident at that time. There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 13, 2025

Type of visit: Case Management - Incident

Unannounced case management visit conducted out at this facility on 10/29/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Rebecca Cobb who was briefly interviewed at this time. Also present was the Resident Care Director Michelle Rodriguez. Current census was 61 residents. The purpose of this case management visit was to discuss the Unusual Incident Reports (UIRs) that were submitted into CCL for the time frame of 08/01/2025 to 10/01/2025. These UIRs were submitted into CCL for a total of (5) residents at that time. This LPA was present to discuss the background behind the incidents, follow-up by this facility and it's staff, and updated care plan related to each individual resident at that time. There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kesha Lewis arrived and opened a case management regarding Multiple incident reports dating from 03/09/2025 to 03/10/2025 involving four (4) residents. LPA met with the administrator and explained the purpose of the visit. The incident reports ranged from a foot injury, fall, anxiety attack and an open sore. The LPA requested the Needs and services plans, Physician's reports (LIC 602), care notes and discharge paperwork for all residents involved. LPA will return at a later date after reviewing all documents to deliver any findings for the incidents referenced above. These matters are still under investigation. No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, May 14, 2025

Allegation investigated: Staff did not treat resident with respect.

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to open a complaint for the above allegation. LPA was greeted by adminstrator and explained the reason for the visit. LPA Lewis interviewed S1-S2 and R1-R2 during this visit also the facility made copies of R1'S service plan. physicans report,SIR and care notes. Based on interviews with staff and residents it is found that the allegation that Staff did not treat resident with respect is UNSUBSTANTIATED. Allthough there was an inside that occored at the facility there is no substainating evidence that R1 was not treated with respect based on interviews with everone involved. Note that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was held and a copy of this report was given. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 26, 2025 · control 27-AS-20250320101132

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Jason Lund arrived at the facility unannounced to conduct an annual/required visit. LPA Lund met with Rebecca Cobb, Administrator and discussed and explained the reason for the visit. Census: 62 LPA Lund & Administrator Rebecca Cobb toured/ inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV areas, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is an 80-bed facility with which has 51 rooms available for residents. The hot water temperature was measured at 117 degrees Fahrenheit in one bathroom. LPA observed fire extinguishers that were fully charged that had been last checked on 06/03/24. Smoke and carbon monoxide detectors were also identified in the facility. A Fire Safety drill report was reviewed as well. Central air was functioning in the facility. LPA observed enough food to support residents and staff for 2- days and enough non-perishables for 7- days. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA reviewed six residents’ files and five staff files and are in compliance. Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies observed or cited. Exit interview held, copy of report given.the state’s words, verbatim · CDSS document, Oct 30, 2024

Allegation investigated: Staff mismanaged residents’ medication Staff did not ensure that the facility was kept clean Staff threatened residents with eviction Staff did not provide a safe and comfortable environment for residents

On 8/13/2024 at 12:31pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the allegations noted above. LPA met with Administrator Rebecca Cobb and explained the purpose of the visit. During this investigation, LPA conducted interviews with five staff members and three residents in care. Additionally, LPA conducted record reviews of medication log sheets, staffing schedule, and housekeeping schedule. LPA also conducted a facility observation on 07/10/2024 and 08/13/2024. . Allegation: Staff mismanaged residents’ medication. LPA conducted interviews, observations, and record reviews as noted above. Based on evidence reviewed, it was determined that facility is currently maintaining medication storage adequately including the use of locking mechanisms and inaccessibility to residents in care. It was further revealed through record reviews and interviews that facility has provided prescribed medications to residents in care consistently and adequately. Interviews conducted did not reveal any corroborated statements of mismanaged medication. {Cont. on 9099C} Unsubstantiated As a result, there is no preponderance of evidence to conclude that staff has or is currently mismanaging residents’ medication, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff did not ensure that the facility was kept clean. LPA conducted interviews and record reviews as noted above. Based on observation, LPA determined that facility is maintaining a clean environment for residents including no malodorous occurrences or excessive stains on walls or floors in common areas and kitchen. An observation of various resident rooms determined a clean and sanitary environment. Interviews and record reviews revealed an adequate cleaning schedule in place necessary to meet the housekeeping needs of the facility. As a result, there is not a preponderance of evidence to conclude facility has not maintained cleanliness, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff threatened residents with eviction. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that there is currently no resident under consideration for eviction. Additionally, interviews conducted revealed no corroborated statements of facility staff using verbalization in a threatening manner to suggest evictions for any reason. As a result, there is not a preponderance of evidence to conclude staff threatened residents with eviction, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff did not provide a safe and comfortable environment for residents. LPA conducted observation and interviews as noted above. LPA’s observations revealed facility is currently meeting the standard of a safe and comfortable environment for residents. LPA observed facility to maintain an adequate temperature throughout facility and within regulatory guidelines. Observations also revealed doors, bathroom fixtures, lighting, and furnishings within common areas and resident bedrooms to be functioning adequately. LPA observed facility’s designated smoking area to contain table and chairs used by residents to be within 20-25 feet or more of facilities entrance. {Cont. on 9099C} A door leading to the smoking area was observed to be shut during LPA’s observation. Interviews conducted did not reveal any corroborated statements of facility not maintaining a safe and comfortable environment. As a result, there is not a preponderance of evidence to conclude staff is not providing a safe and comfortable environment for residents, therefore this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Rebecca Cobb and a copy of this report was provided to Rebecca. Appeal rights provided.the state’s words, verbatim · CDSS document, Aug 13, 2024 · control 27-AS-20240626103042

Allegation investigated: Staff mismanaged resident medication.

Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 05/23/2024 at 12:50 PM to deliver complaint findings, LPA Martinez met with Rebecca Cobb and explained the purpose of the visit. Throughout the course of the investigation, LPA Martinez conducted interviews and reviewed facility files. The investigation revealed resident 1 (R1) was not administered Insulin per medication orders. R1 was not administered insulin on April 11 thru 14, 2024. On April 15, 2024, R1 was sent to the Emergency Room (ER), which R1 was admitted into the hospital. R1 did not return to River Fountains of Lodi. As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D page, per Title 22 Regulations. An exit interview was conducted, and a copy of this 809 report, 809D page, and appeals rights were given to the facility. Substantiatedthe state’s words, verbatim · CDSS document, May 23, 2024 · control 27-AS-20240508103430

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 23, 2024

87465(a)(4) Incidental Medical and Dental Care: A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by: Based on file review and interviews, the Licensee did not ensure R1 was assisted with administering Insulin as prescribed by their physician. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Facility has completed an Incidental Medical and Dental trainings for all Med-Techs on 05/17/2024 and 05/23/2024. POC Cleared at visit.