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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701180
Report Date: 04/04/2024
Date Signed: 04/04/2024 01:02:37 PM


Document Has Been Signed on 04/04/2024 01:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 74DATE:
04/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tony Montellano, Executive DirectorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPAs) Renee Campbell and arrived at the facility to conduct an unannounced annual inspection on 04/04/24.  LPA Campbell met with,Tony Montellano, Executive Director and explained the purpose of the visit.

LPA Renee Campbell toured the facility with the Executive Director Tony Montellano and inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, and outside courtyards of the facility to ensure compliance with Title 22 regulations. This facility is a single story building licensed to serve one-hundred (100) non-ambulatory residents, of which eight (8) may be bedridden and ten (10) may have a hospice waiver.  LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. A fountain was observed in use outside but it was locked behind a gate. There are no other bodies of water present.

LPA observed sufficient seven-day non-perishable and two-day perishable food supplies. The hot water temperature was measured in two bedrooms. One resident's bathroom water temperature measured at 110.7 degrees Fahrenheit.. LPA then measured another residents bathroom on the other side of the facility at 114.4 degree Fahrenheit. Fire extinguishers, smoke and carbon monoxide detectors are in good repair. Facility thermostat observed at 75 degrees Fahrenheit. LPA requested staff files for review. LPA reviewed 6 resident files. Toxins were made inaccessible to clients in care. Toxins are stored in the laundry room and staff maintenance closets.
Current census was 74.

LPA reviewed 6 staff files.
Due to insufficient time, LPA will come at a later date to conduct a continued annual.
No deficiencies or citations provided during the course of this visit.
An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024
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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