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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500310664
Report Date: 06/12/2023
Date Signed: 06/12/2023 03:14:20 PM


Document Has Been Signed on 06/12/2023 03:14 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: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: 37DATE:
06/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Administrator Sister Margaret M. HomaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jason Lund conducted an unannounced annual/required inspection visit. LPA Lund met with Administrator Sister Margaret M. Homa and explained the reason for the visit. The facility has a hospice waiver for 5 residents. Census 37

LPA Lund & Administrator Sister Margaret M. Homa toured/inspected the interior and exterior of the facility. LPA observed an activity calendar and residents engaging in an activity. The facility is found to be clean, sanitary, and in good repair. The facility temperature is at 74.5 degrees F. There are no bodies of water present. LPA observed sufficient food supply and observed a menu. Fire extinguishers (service tag 6/5/2023), sprinkler system (5-year service conducted on 3/19/2022), and carbon monoxide detector are in compliance. First aid kit is complete.

LPA reviewed a sampling of (4) resident and (4) staff files (reviewed staff has criminal record clearance). LPA observed centrally stored medications are locked.



No deficiencies were observed and cited during this visit. Exit interview held with Sister Margaret M. Homa and a report given.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
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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