500301453-6-23-2022-27-AS-SDOB-CG5W47-20220708165703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500301453
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:09:06 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
04/15/2022 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20220415093516

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: 314	DATE:	06/23/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Associate Executive Director Jiane Bassi		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Unlawful eviction

Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to complete a complaint investigation regarding the above allegations. LPA Lund meet with Associate Executive Director Jiane Bassi and explained the reason for the visit.
LPA Lund reviewed facility records interviewed staff, residents and witnesses regarding the above allegations.
Unlawful eviction- The facility and Resident (R1) family did multiple assessments with doctors and concluded on June 13, 2022 that the family will return the property back to Covenant Living of Turlock on July 17, 2022.
At the June 13, 2022 care conference, R1’s family agreed that it was not safe for R1 to return to R1’s residential living apartment. Among the reasons for this are R1’s dementia diagnosis by two physicians and the need for a 2- person assistance since May 1, 2022. In the care conference the family and R1 all agreed that it would be a good goal for R1 to work toward a transfer from the care center to assisted living. With this goal in mind, the family agreed this was the best for R1. We discussed a date to return R1’s residential living apartment to Covenant Living of Turlock on July 17.

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: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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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Control Number 27-AS-20220415093516

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COVENANT LIVING OF TURLOCK	FACILITY NUMBER: 500301453
	VISIT DATE: 06/23/2022

NARRATIVE

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Through this entire process at the Covenant Living of Turlock Care Center. R1 physicians would not write a discharge order for R1 to return to residential living apartment due to lack of a safe discharge plan.

Facility is in disrepair- 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 was 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 Associate Executive Director Jiane Bassi and a copy of report was left.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC9099 (FAS) - (06/04)

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