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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701180
Report Date: 05/16/2023
Date Signed: 08/04/2023 09:26:23 AM


Document Has Been Signed on 08/04/2023 09:26 AM - 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:COGIR OF TURLOCKFACILITY NUMBER:
502701180
ADMINISTRATOR:JOHNS, JANETFACILITY TYPE:
740
ADDRESS:3791 CROWELL ROADTELEPHONE:
(209) 664-9500
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:100CENSUS: 83DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Executive Director Anthonty Montellano. TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual/required inspection and met with Executive Director Anthonty Montellano and explained the reason for the visit. Current census was 83 residents.
LPA Lund and Executive Director Anthonty Montellano tour/inspected the facility was conducted.
The activity areas and common areas for resident use were inspected. Furniture and furnishings were observed to be present and sufficient to meet the needs of the residents at this time.
Office rooms and other areas intended for resident use were toured. A review of the facility public restrooms was conducted.
Hot water temperatures were taken to make sure that the hot water being dispensed was within the allowed range of 105-120 degrees at this time.
Fire extinguishers, placed throughout this facility, were observed to have been annually inspected on 05/05/203 by the local fire extinguisher company, Jorgensen Company, and in compliance at this time.
Kitchen area was toured. Facility freezer and refrigerator units were toured. LPA reviewed the food storage supply to make sure that there was always a 2-day perishable and 7-day nonperishable food quantities on site at all times. Storage area for chemicals and cleaning supplies was observed to be locked and made inaccessible to the residents at this time.
Memory Care unit for this facility was toured. Delayed egress and other safety measures were observed to be functional at this time.
Exterior grounds of this facility was toured.
Perimeter fence and gates were observed to be functional and in good repair at this time.
Entrances and exits used were observed to be supplied with hand sanitizer and masks at this time.
This facility has been observed to be in compliance at this time.
LPA Lund reviewed 10 residents and 8 staff files.
There were no deficiencies observed during the course of this visit.
Exit Interview and report left.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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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