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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500310664
Report Date: 06/23/2021
Date Signed: 06/23/2021 12:31:47 PM

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:ST. THOMAS RETIREMENT CENTERFACILITY NUMBER:
500310664
ADMINISTRATOR:SR.BASIMA MARGARET HOMAFACILITY TYPE:
740
ADDRESS:2937 NORTH BERKELEY AVENUETELEPHONE:
(209) 634-7252
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:49CENSUS: DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Sister Margaret M. Homa TIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs) Jason Lund & Sarah Hurt conducted an unannounced annual facility inspection and met with Sister Margaret M. Homa.

LPAs inspected the interior and exterior of the facility. The facility is found to be clean, sanitary, and in good repair. LPAs observed sufficient food supply and observed a menu. LPAs observed fire extinguishers (Expires on May 11, 2022) and carbon monoxide. LPAs observed centrally stored medications are locked.


Exit interview conducted with Sister Margaret M. Homa copy of LIC 809 provided.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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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