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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 07/14/2026
Date Signed: 07/14/2026 05:30:33 PM

Unsubstantiated


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
07/06/2026 and conducted by Evaluator Noel Wolf Petersen
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260706094019
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:
07/14/2026
UNANNOUNCEDTIME BEGAN:
03:24 PM
MET WITH:Jackie HernandezTIME COMPLETED:
03:25 PM
ALLEGATION(S):
1
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9
facility had mismanaged a residents medication
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
10
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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.

The record review of the perscriptive orders of the R1's medications do not reveal a measuring scale for determining how much or how little medication to distribute. The order as written is "apply to affected areas, 2x daily as needed for pain" without indication to a specific amount that would exceed "as needed." Clarification from a doctor was sought, the advisory was returned "do not apply to more than one affected area at time". LPA was informed of a bottle of nasal suspension for r1 had a suspicsious origin. LPA interviewed the facility Health and Wellness Director S3, who made the statement that over the counter medications, if they are out of the facility when the client needs them as part of a regular perscription, the facility policy is to go supply the medication from the pharmacy to meet the needs of the clients. record review of the MAR for R1, does not provide any indication that a dose for a medication was missed in the past two weeks. Two medtechs were interviewed, both indicated no order perscribed a specific amount of topical medcation and orders wer followed as perscribed.

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.
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)
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