500301453-2-10-2026-27-AS-NWPN-DR6VF4-20260210152319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500301453
Report Date: 02/10/2026
Date Signed: 02/10/2026 03:23:29 PM

Document Has Been Signed on 02/10/2026 03:23 PM - 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:	COVENANT LIVING OF TURLOCK		FACILITY NUMBER:	500301453
ADMINISTRATOR/ DIRECTOR:	RYAN HUST		FACILITY TYPE:	741
ADDRESS:	2125 N OLIVE AVENUE		TELEPHONE:	(209) 632-9976
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY: 377		CENSUS: 167	DATE:	02/10/2026
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:45 AM
MET WITH:	Ryan Hust		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility to conduct a case management related to the recent cluster of falls. LPA met with administrator Ryan Hust, to explain the purpose of the visit. Covenant Living of Turlock is a 377 bed facility where 167 of the beds have clients in a condition of being provided care. LPA toured several rooms and apartments of the facility, asked for SI reports related to falls for the past 2 weeks, asked for a copy of Plan of OP selections related to employee training including any specific related issue to falls including reporting requirements, and Shift schedules for a period of days. The toured locations of the falls for the past two weeks(aspen, sequoia, redwood), LPA identified no environmental risks for increased falls (torn rugs/trip hazards, unsecured bannisters/grab bars). LPA notes the Plan of Op was last updated in 2015, and is requesting any updates of the past 11 years be sent along in a revised plan of OP to the LPA's email by March 10th 2026. (noel.wolfpetersen@dss.ca.gov) . Per the facilities Policy training on Medical Emergencies, "the community summons 911 when the resident exhibits signs and symptoms of distress and/or emergency condition: ...to include fall with deformity, severe pain or head injury...". Does not designate seperate policy for witnessed or unwitnessed falls, nor situations where behavioral expression or pathology prevents an expression of pain. 3 of 5 falls in SI reports from the past 6 weeks included a phonecall to 911, responsible party, and a physician. the remaining 2 of 5 falls in SI reports from the past 6 weeks fell outside of the plan of op's stated reporting criteria, asserted to have been determined by the facilities reporting parties. One SI report of these two included bruising on the hands and knees. One client of these two was inclined to be interviewed, and denied feeling as though there was a shortfall in the care and supervision by the staff related to the fall. Continued on C-Page

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Noel Wolf Petersen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: COVENANT LIVING OF TURLOCK	FACILITY NUMBER: 500301453
	VISIT DATE: 02/10/2026

NARRATIVE

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Per administrator melina Nunez, Employees are trained about the fall policy several times in a year. Per staff(sequoia), It occurs about once or twice a year, three Staff Interviewed(sequoia) were somewhat able to review the fall policy and indicated the training leaned heavier on reporting requirements rather than the approach to the client. LPA's review of the shift schedules for several affected areas (sequoia, aspen, redwood) in the given times indicate that the facility was fully staffed at the times of the falls.

Per adminstrator Ryan Hust, the facility has multiple redundant systems that are operational to alert staff in the event of a fall: Emergency pull cords in the public bathrooms, and emergency pendants are equipped to the residents, a nurses phone number given to the residents, and staff that move through the buildings with regular frequency (3+ times a day) and are able to respond to cries for help. Fall reporting is attended to in a verbal pass down between shifts and a client file, after a fall 72 hour report checklists are given the staff to assess the client in more detail, updates are forwarded to managers if the reporting staff identify any kind of risk.

The LPA's concerns regarding the facilities fall prevention policies are satisfied at this time. LPA gave guideance to conduct a updated policy training for Medical Emergencices, soon and at least once a year, to include how to identify risks to the onboarding clients including falls, to understand appropriate 911 intervention approaches for witnessed and unwitnessed falls, the unique supervision and care concerns of the clients with fall risk who also have a dementia or are otherwise unable to report pain verbally, as well as what situations where changes in a clients welfare would trigger a LIC 624 notification of a significant incident to licensing. LPA gave additional guidance to observe a general maxim if a fall is unwitnessed, call for emergency send out and allow any client refusal/deteriminations of medical necessity to play out with the ambulance, and document as much of the process as possible.

No citations were issued. a copy of the report was read and given to the administrator. exit interview was conducted.

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Noel Wolf Petersen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026

LIC809 (FAS) - (06/04)

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