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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500310664
Report Date: 08/22/2024
Date Signed: 08/22/2024 02:39:54 PM


Document Has Been Signed on 08/22/2024 02:39 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 38DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sister Margaret Homa, Administrator TIME COMPLETED:
02:45 PM
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On 08/22/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility and observed a camera in the living room of a resident's suite. No camera's were observed in the bathroom or bedroom.

Upon review of C1's file, there was no documentation of C1 having cameras in their room. When asked, D1 reported that the family wanted C1 to have the camera because C1 suspected staff of taking things and the family wanted to be able to check on C1 in case they fell. The facility did not provide the camera and did not maintain the camera.

Using interpretation services, LPA Campbell met with C1 and asked if they were okay with having the Camera in their room. C1 stated that they were fine with having the camera there.
Exit interview conducted and report provided to Administrator.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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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