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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 06/17/2026
Date Signed: 06/17/2026 05:10:45 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
06/02/2026 and conducted by Evaluator Noel Wolf Petersen
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260602090314
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: DATE:
06/17/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jackie HernandezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is mismanaging medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, LPA, Noel Wolf Petersen arrived to the facility to conduct a investigation into the above allegations. The LPA met with Executive Director Jackie Hernandez, and explained the purpose of the visit.

In interview with the administrator and staff it was learned, a staff had mistakenly distributed a medication to a resident, the staff has since reviewed the rights of medication dispersal and recieved a written warning regarding the incident and recived sadow training which is ongoing. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.)

1 resident interviewed.

Citation issued as part of this visit, A copy of the report was read and given to the administrator, appeal rights were provided, an exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026
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 4
Control Number 27-AS-20260602090314
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: 06/17/2026
NARRATIVE
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As to the allegation that a resident was given another residents medication, the LPA reviewed the Log of the mar and interviewed two med techs, who were in agreement that the residents received corrected medications and dosages, excepting an incident for which medication mismanagment was cited as part of this complaint, where Eyedrops not perscribed to another resident were left on the cart of the same brand and given to a resident by mistake. Other medications on the log are described as being given appropriately. 2 medtech Staff are confirming in interview that other medications prescribed to the client were given appropriately to the orders as prescribed.

1 resident was interviewed.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A copy of the report was read and given to the administrator, appeal rights were provided, exit interview conducted.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
06/02/2026 and conducted by Evaluator Noel Wolf Petersen
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260602090314

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: DATE:
06/17/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jackie HernandezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is not managing resident's incontinence
Facility is administering other resident's medications to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, LPA, Noel Wolf Petersen arrived to the facility to conduct a investigation into the above allegations. The LPA met with administrator Jackie Hernandez, and explained the purpose of the visit.

As to the allegation that the facility was not managing the residents incontinence, The LPA reviewed the facility daily log and care notes for the residents incontinence, the log supports changes multiple times a day, in accorance with the current care plan describing the needs of the resident as 3x times daily. In intervew 4 staff characterized their services to the clients incontinence care as often as every hour an a half, all four thought the care plan was at least every 2 hours. The LPA gave guidance that if the clients needs are characterized by the staff as significantly more frequent than 3x daily, the care plan should be changed to fit those needs, also standardizing the inclusion of the time of services rendered in the care notes might assist with the regulation of those services between shifts.

continued on c page.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20260602090314
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: 06/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2026
Section Cited
CCR
87465(a)(2)
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87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:

(2) The licensee shall provide assistance in meeting necessary medical and dental needs...

This requirement was not met as evidenced by:
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No POC, the staff have developed and implemented a plan to correct the medtech who had distributed the medication, which involved a review training, a shadowing period, and a write up.
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In interview with administrators and staff it was learned that at least one resident was given medication that was not thiers.

this poses a risk to the health and safety and personal rights of the residents 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.
SUPERVISOR'S NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4