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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 01/29/2026
Date Signed: 01/29/2026 12:58:43 PM

Substantiated


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
12/02/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251202092711
FACILITY NAME:COGIR OF TURLOCKFACILITY NUMBER:
502701180
ADMINISTRATOR:HERNANDEZ, JACKIEFACILITY TYPE:
740
ADDRESS:3791 CROWELL ROADTELEPHONE:
(209) 664-9500
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:100CENSUS: 77DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jackie Hernandez TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff provided a meal to resident that contained a known food allergen
INVESTIGATION FINDINGS:
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On 1/29/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA was met by Facility Designated Administrator (FDA), Jackie Hernandez and explained the purpose of the visit. The purpose of this visit was deliver complaint findings for the allegations above.

Current census was 77.
It was alleged that facility staff served a resident a meal containing a known food allergen. During the investigation, the department conducted interviews and reviewed facility records. Based on interviews with facility staff, it was confirmed that on 11/26/2025, during lunch, a staff member observed S1 consuming clam chowder. Facility staff reported that they were notified by a family member that the resident had a shellfish allergy. Kitchen staff subsequently confirmed that the soup contained shellfish.A review of facility records revealed that on 07/30/2024, the resident’s dietary needs were updated. A communication notice reflecting this change was completed and signed on that date to notify facility staff.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20251202092711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COGIR OF TURLOCK
FACILITY NUMBER: 502701180
VISIT DATE: 01/29/2026
NARRATIVE
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Based on the information gathered, the facility staff did serve a meal to the resident with a known food allergen.
As a result of this investigation, the department found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.
The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.
An exit interview was conducted and a copy of this report and appeals rights was provided to the facility at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20251202092711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: COGIR OF TURLOCK
FACILITY NUMBER: 502701180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2026
Section Cited
CCR
87464(f)(4)
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(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.
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The facility designated Administrator stated that facility staff shall be sufficient and able to meet the needs of the residents at all times. Training, for no less than (1) hour in duration, will be conducted and completed for all facility staff providing care and supervision to the residents at this time. The topic shall cover the policies and procedures for this facility's
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This was not met was evidenced by: Based on interview and record review, the licensee did not follow the assistance and care needs of the residents as indicated in their pre-admission appraisal for assistance in meals, food allergies, and eating. It was learned that facility staff provided the resident with a known allergen during meal time. This presented an immediate threat to the Health, Safety, and Personal Rights of the residents in care.
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meal service, food allergies, and ADLs delivered to the residents in care. A statement of correction, along with proof of training topic, trainer information, and list of attendees will be completed and submitted into CCL by the due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3