500301453-11-21-2023-27-AS-LRIS-CY7TAP-20231204133351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500301453
Report Date: 11/21/2023
Date Signed: 11/21/2023 02:23:22 PM

Substantiated

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
08/24/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20230824155849

FACILITY NAME:	COVENANT LIVING OF TURLOCK		FACILITY NUMBER:	500301453
ADMINISTRATOR:	RYAN HUST		FACILITY TYPE:	741
ADDRESS:	2125 N OLIVE AVENUE		TELEPHONE:	(209) 632-9976
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	377	CENSUS: 283	DATE:	11/21/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Executive Director Ryan Hust		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff member accessed resident credit card account without authorization

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Executive Director Ryan Hust and explained the reason for the visit.

Staff member accessed resident credit card account without authorization-Based on records review, and interview with Executive Director Ryan Hust. On 8/29/2023 Administrator Ryan Hust reported to Community Care Licensing that a staff member (S1) did fraudulent activity on resident’s (R1) credit card in the sum of $19250.16 at the time. The facility reported it to the Turlock PD with report #TP23005126. On 11/15/2023 the facility paid the sum of $57862.92 to R1for the apparent loss of money to R1. The facility provided a detailed list of money owed to R1.

Substantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 27-AS-20230824155849

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: COVENANT LIVING OF TURLOCK	FACILITY NUMBER: 500301453
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/21/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/22/2023 Section Cited CCR 87217(a)	1 2 3 4 5 6 7	A licensee shall not be required to handle residents' cash resources. However, if a resident incapable of handling his own cash resources.......	1 2 3 4 5 6 7	Executive Director returned the sum of $19250.16 to R1. S1 didn't return to the facility.
	8 9 10 11 12 13 14	This was not met as evidenced by: S1 did fraudulent use R1’s credit card in the sum of $19250.16. This poses an immediate health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20230824155849

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: COVENANT LIVING OF TURLOCK	FACILITY NUMBER: 500301453
	VISIT DATE: 11/21/2023

NARRATIVE

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As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiency was cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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