502701180-7-14-2026-27-AS-LKIG-DW9UBY-20260723152707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 07/14/2026
Date Signed: 07/14/2026 05:31:32 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
06/15/2026 and conducted by Evaluator Noel Wolf Petersen

COMPLAINT CONTROL NUMBER: 27-AS-20260615110219

FACILITY NAME:	COGIR OF TURLOCK		FACILITY NUMBER:	502701180
ADMINISTRATOR:	HERNANDEZ, JACKIE		FACILITY TYPE:	740
ADDRESS:	3791 CROWELL ROAD		TELEPHONE:	(209) 664-9500
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	100	CENSUS:	DATE:	07/14/2026
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Jackie Hernandez		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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9

Facility did not provide appropriate care and supervision resulting in a harm/injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst, LPA, Noel Wolf Petersen arrived to the facility unannounced to investigate a complaint investigation with the above allegation, LPA met with Executive Director Jackie Hernandez to discuss the findings.

Specificly a large but first degree burn via some heated juice. In interview, the staff S1 reported that they had heated a prune juice and left it with the client. Record review of 602 for R1 indicates he has dementia and assistance with feeding. Administrator provided that the staff had recived a generalized training as a result of the incident about providing the clients with heated fluids. LPA asked for a log of the training.

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, are being cited on the attached LIC 9099D.

A citation was issued, a copy of the report was read and given to the administrator, appeal rights were provided. exit interview was conducted.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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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
06/15/2026 and conducted by Evaluator Noel Wolf Petersen

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260615110219

FACILITY NAME:	COGIR OF TURLOCK		FACILITY NUMBER:	502701180
ADMINISTRATOR:	HERNANDEZ, JACKIE		FACILITY TYPE:	740
ADDRESS:	3791 CROWELL ROAD		TELEPHONE:	(209) 664-9500
CITY:	TURLOCK	STATE:CA	ZIP CODE:	95382
CAPACITY:	100	CENSUS:	DATE:	07/14/2026
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Jackie hernandez		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not seek timely medical attention for a serious harm/injury

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst, LPA Noel Wolf Petersen arrived to the facility unannounced to investigate a complaint investigation with the above allegations, LPA met with Executive Director Jackie Hernandez to discuss the findings.

Specificly it was alleged that the facility presented a barrier to timely medical attention in the response to a large but first degree burn via heated juice. LPA interviewed S1, who indicated that a Medtech had called 911. S2 and S3 were medtechs on duty, S2 recalls that she had called 911 after the second burn was discovered between 9:10 and 9:30 am. LPA asked for a call log from the time of the incident. The facility administrator provided the statement, a relative of r1 had attempted to arrange transportation to a urgent care and expressed being opposed to hosptialization for r1. Client arrived to the hospital, via EMT sometime between 9:15 and 10:00, resident did not refuse trasportation as reported to be provided by the facility

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 left with the administrator. exit interview was conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026

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 3

Control Number 27-AS-20260615110219

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: 07/14/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/15/2026 Section Cited CCR 80078(a)	1 2 3 4 5 6 7	80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidinced by:	1 2 3 4 5 6 7	No immediate poc, the corrective action taken by the facility to do a staff training about the care for residents as related to heated fluids is what the department would have recommended, training was completed on June 16th 2026 for all staff.
	8 9 10 11 12 13 14	In interview with S1, the staff is reporting that they heated and left a heated juice with the resident r1, record review of 602 for r1 indicates assistance with feeding/drinking. This requirement not being followed risks the clients health, safety, or personal rights.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 07/14/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026

LIC9099 (FAS) - (06/04)

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