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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500301453
Report Date: 09/26/2022
Date Signed: 09/26/2022 12:35:07 PM


Document Has Been Signed on 09/26/2022 12:35 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:COVENANT LIVING OF TURLOCKFACILITY NUMBER:
500301453
ADMINISTRATOR:RYAN HUSTFACILITY TYPE:
741
ADDRESS:2125 N OLIVE AVENUETELEPHONE:
(209) 632-9976
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:377CENSUS: 274DATE:
09/26/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Executive Director Ryan Hust TIME COMPLETED:
12:45 PM
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LPA Jason Lund arrived at the above facility unannounced to conduct a proof of correction visit. LPA Lund met Executive Director Ryan Hust with and explained the reason for the visit.

On 5/19/2022 the facility received two deficiencies, Covid-19 protocols were not followed and Medical attention for resident(s) not sought in a timely manner. On 5/20/2022, the facility initiated training and emailed LPA Lund a copy of such training for staff.

Exit interview conducted with Executive Director Ryan Hust and report provided.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2022
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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