500301453-5-12-2022-27-AS-SDOB-CEL7EP-20220519213616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500301453
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:20:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/16/2022 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20220216154020

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: 271	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Executive Director Ryan Hust		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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On 5/12/2022, Licensing Program Analyst (LPA) Jason Lund arrived at the facility unannounced to complete a complaint investigation regarding the above allegation. LPA Lund meet with Executive Director Ryan Hust and explained the reason for the visit.
LPA Lund reviewed facility records interviewed staff, residents and witnesses regarding the above allegation.
Based on records review, interviews with witness, residents and staff. The facility records indicate that Resident (R1) room had work orders 9/3/2021 through 11/30/201 and all work orders were done expect for the work order on 11/30/2021 because the R1 requested that R1 be present during the time of work being done in the room. R1 has been at the skilled nursing center of the facility since 12/1/2021 and the facility has is waiting for the R1 to be present for work to be done in the room.
As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Exit interview was conducted with Executive Director Ryan Hust and a copy of report was left.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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

LIC9099 (FAS) - (06/04)

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