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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 02/27/2026
Date Signed: 02/27/2026 01:58:12 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
08/18/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250818101558
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:
02/27/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jackie HernandezTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not inform resident's responsible party of incidents.
INVESTIGATION FINDINGS:
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On 02/27/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings.
LPA Pascua met with Facility Designated Administrator (FDA), Jackie Hernandez and explained the purpose of the visit.
Current census was 77. A brief interview with FDA Hernandez was conducted.
Staff did not inform resident's responsible party of incidents.
It was alleged that the staff did not inform resident’s responsible party of incidents. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on conducted interviews, it was determined that on 05/26/2026 the facility reported an unwitnessed fall to the hospice agency. When asked whether the facility notified the resident’s responsible party of the fall, facility management stated that the hospice agency was informed and that it was the hospice agency’s responsibility to notify the responsible party.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
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 6
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
08/18/2025 and conducted by Evaluator Arielle Pascua
COMPLAINT CONTROL NUMBER: 27-AS-20250818101558

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:
02/27/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jackie HernandezTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to resident resulting in resident falling.
Staff did not assist with resident's bathroom needs.
Staff did not properly discharge resident.
INVESTIGATION FINDINGS:
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On 02/12/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings.
LPA Pascua met with Facility Designated Administrator (FDA), Jackie Hernandez and explained the purpose of the visit.
Current census was 77. A brief interview with FDA Hernandez was conducted.
Allegation: Staff did not provide adequate supervision to resident resulting in resident falling.
It was alleged that staff did not provide adequate supervision to resident resulting in resident falling. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted with 5 staff members. 5 out 5 deny that the facility did not provide adequate supervision to the resident resulting in the resident falling. 5 out of 5 staff members state that they conduct routine checks on all residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20250818101558
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: 02/27/2026
NARRATIVE
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However, 5 out 5 staff members report that the residents may have unwitnessed falls as they cannot prohibit the resident from falling but can assist to mitigate the falls. In addition, a review of the resident’s care plan dated on 05/26/2025, states that the resident may be a fall potential however the fall risk was scored as 0. This was acknowledged and signed by the resident responsible party on 05/26/2025. Based on the information gathered, there is not sufficient evidence to prove that staff did not provide adequate supervision to resident resulting in resident falling.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

Allegation: Staff did not assist with resident’s bathroom needs.

It was alleged that staff did not assist with resident’s bathroom needs. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted with 5 staff members. 5 out 5 staff members deny that they did not assist with the resident’s bathroom needs. 5 out 5 staff members state that they assist residents as needed. 5 out 5 staff members state that residents may have to wait for a couple minutes to get assistance however will always assist the residents. An interview with 5 residents were conducted. 5 out 5 residents denied not being assisted with their bathroom needs. Based on the information gathered, there is not sufficient evidence to prove that staff did not assist the residents with their bathroom needs.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20250818101558
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: 02/27/2026
NARRATIVE
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However, a review of the facility’s Plan of Operation, page 54, Reporting Requirements (6)(d), states: “any incident which threatens the welfare, safety or health of any residents, such as the following: falls…” must be reported. Additionally, page 55, Medical Emergencies, states: “In an event of a non-serious emergency…the physician will be contacted immediately for advice regarding treatment, the physician’s recommendations will be followed and documented, and the family contacted to report the incident.”

Based on the information obtained, facility staff did not notify the resident’s responsible party of the incident.

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: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20250818101558
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: 02/27/2026
NARRATIVE
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Allegation: Staff did not properly discharge resident

It was alleged that the staff did not properly discharge resident. During the course of this investigation, LPA Pascua conducted interviews and reviewed facility records. Based on interviews conducted, it was learned that this resident was at the facility for 1 week for respite care with assistance from Hospice. It was stated by facility management that due to the resident being on respite, the facility would be notified by the responsible party or hospice when the resident would leave. It was stated that the family would pick the resident up. A review of the facilities records show that the facility discharged the resident’s medication and belongings with the responsible parties signature acknowledging that they had obtained everything for the resident. Based on the information gathered, there is not sufficient evidence to show that the staff did not properly discharge the resident.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of the report was given to Jackie Hernandez.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20250818101558
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: 02/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2026
Section Cited
CCR
87211(a)(1)
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(a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:
(1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case
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Facility administrator states that a statement correction will be provided stating that the facilities new implementation and reporting requirement procedures.

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This is not met as evidenced by: Based on interviews and record review, the licensee did not ensure that a resident’s responsible party was notified after a fall incident. This poses a potential health, safety, and personal rights risks to persons in care.
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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: 02/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6