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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 07/15/2025
Date Signed: 07/15/2025 05:13:26 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
07/09/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250709140117
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: 78DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Jackie Hernandez, AdministratorTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff did not ensure resident’s signaling equipment was maintained in operable condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Renee Campbell arrived to the facility unannounced to open a complaint. LPA Campbell met with Jackie Hernandez, Administrator and explained the purpose of the visit.

Regarding the allegation that staff did not ensure resident’s signaling equipment was maintained in operable condition, LPA Campbell observed that notifications were not heard or responded to by staff. LPA Campbell observed that when R9 pulled their cord, the call was received by the Memory Care phone but could not be heard. When asked, S4 stated that they had been experiencing problems with the Memory Care phone receiving notifications from residents.

Based on LPA’s observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
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: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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 2
Control Number 27-AS-20250709140117
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: 07/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2025
Section Cited
CCR
87303(i)(1)(B)
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Maintenance and Operation (i) Facilities shall have signal systems which shall ...
(B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff.
This requirement is not met as evidenced by:
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The licensee will conduct an in-service regarding the Call System phone and relay consequences such as written warnings and possible termination for reducing the volume needed for notifcation & safety. The licensee will email the in-service sign in sheet to LPA Campbell by POC due date
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Based on observation and interviews, the licensee did not ensure the facility had a signal system that was able to summon staff based on statements by S4 and observations of LPA Campbell which poses an Immediate Health, Safety or Personal Rights risk to persons 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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2