500310664-9-5-2024-27-AS-KHOS-D9MTUB-20241001150204

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500310664
Report Date: 09/05/2024
Date Signed: 09/05/2024 03:57:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/03/2024 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20240703144147

FACILITY NAME:	ST. THOMAS RETIREMENT CENTER		FACILITY NUMBER:	500310664
ADMINISTRATOR:	SR.BASIMA MARGARET HOMA		FACILITY TYPE:	740
ADDRESS:	2937 NORTH BERKELEY AVENUE		TELEPHONE:	(209) 634-7252
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	49	CENSUS: 38	DATE:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Camille Duralski, Administrative Assistant		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff unlawfully evicted a resident

INVESTIGATION FINDINGS:

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On 09/04/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to present findings for a complaint. LPA Campbell met with Camille Duralski, Administrative Assistant and explained the purpose of the visit.

Regarding the allegation that staff unlawfully evicted a resident, no record of a documented eviction notice was found. When F1 was contacted, they reported there had been no discussion of eviction. C1 also stated that no eviction notice was issued. The client was also admitted back to the facility per the notice provided by the administrator.

Based on the information collected there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited. Exit interview was held and a copy of report was given to Camille Duralski.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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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