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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 06/26/2025
Date Signed: 06/26/2025 03:59:42 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
01/23/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250123084448
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: 76DATE:
06/26/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jackie Hernandez, Executive DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff inappropriately solicited money from residents
INVESTIGATION FINDINGS:
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On 06/26/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to present findings for a complaint. LPA Campbell met with Executive Director Jackie Hernandez and explained the purpose of the visit.

Regarding the allegation that staff inappropriately solicited money from residents, when interviewed, the Executive Director stated solicitation is not allowed in the facility as stated in the Admission Agreement. LPA Campbell reviewed the newsletter provided by the community to residents and families requesting donations. According to the most recent admission agreement and/or handbook, staff are not allowed to request donations and this includes the Executive Director.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiency is being cited on the attached 809-D during this visit. An exit interview was conducted, and copies of the report and appeal rights left.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
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-20250123084448
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: 06/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
07/03/2025
Section Cited
CCR
87208(a)
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 87208(a) The licensee shall have and maintain a current... definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation.
This requirement is not met as evidenced by:
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The community will update the handbook addressing the conflict between requesting holiday donations for staff and the No Tipping policy by the POC due date and provide the updated handbook via email to renee.campbell@dss.ca.gov
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Based on interviews and record reviews, the community solicits donations for staff which conflicts with the facility No Tipping policy as found in the community handbook that applies to tips and gifts for services rendered which poses a potential health, safety and personal rights risk.
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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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 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
01/23/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250123084448

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: 76DATE:
06/26/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jackie Hernandez, Executive DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff are not meeting residents needs
Staff did not ensure they have enough supplies for residents
INVESTIGATION FINDINGS:
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On 06/26/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to present findings for a complaint. LPA Campbell met with Executive Director Jackie Hernandez and explained the purpose of the visit.

Regarding the allegation that staff are not meetings residents needs, LPA Campbell interviewed 3 staff and 3 residents. Staff (S1, S2, and S3) reported that they were able to assist with residents ADL's and requests. All staff interviewed had experience working in Memory Care and Assisted Living and stated they were able to meet residents needs in a timely manner. When interviewed, R1, R2 and R3 reported that staff meet their needs daily by assisting with cleaning, laundry and showering. R3 stated that staff will push their wheelchair and watch them when taking a shower to make sure they are safe. To avoid falls, R2 says that staff “make sure I get up and don’t fall”. Though R1 does not need an abundance of assistance, they state that staff does their laundry and assists them with cooking.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
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 4
Control Number 27-AS-20250123084448
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: 06/26/2025
NARRATIVE
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Regarding the allegation that staff did not ensure they have enough supplies for residents, R2 stated that “I don’t need help with toileting but I use wipes sometime. I haven’t noticed them being slow to get.” and R3 said, “I haven’t noticed them running out of wipes or other supplies. I didn’t notice them using paper towels to clean me.” Staff 1 (S1) also stated, “I always make sure I have enough for my shift.” However, she informed LPA Campbell that “staff don’t does not supply wipes, the family must supply that.” As shown in the Admission Agreement under I. Basic Services. (D. Personal Supplies) residents may either provide hygiene supplies themselves or obtain them from Cogir Turlock for an additional charge.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. 
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4