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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507000306
Report Date: 06/23/2022
Date Signed: 06/23/2022 01:38:02 PM


Document Has Been Signed on 06/23/2022 01:38 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:COVENANT CARE-TURLOCK RESIDENTIALFACILITY NUMBER:
507000306
ADMINISTRATOR:RUTH VILLARREALFACILITY TYPE:
740
ADDRESS:1101 E. TUOLUMNE ROADTELEPHONE:
(209) 667-8409
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:49CENSUS: 37DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator Jennifer WarkentinTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct an annual/required visit. LPA Lund met with Administrator Jennifer Warkentin and explained the reason for the visit.

LPA Lund and Administrator Jennifer Warkentin walked the inspected the inside and outside of the facility. The facility is found to be clean, safe, and in good repair. Fire extinguishers (service tag May 2021), smoke detectors, and carbon monoxide detectors are in compliance. LPA observed centrally stored medications are locked. LPA observed sufficient food supply. Fire extinguisher, smoke detectors, and carbon monoxide detectors were found in compliance. First aid kit was complete. The facility temperature was comfortable for residents in care.

Exit interview conducted with Administrator Jennifer Warkentin copy of the report provided.

SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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