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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507000306
Report Date: 06/19/2023
Date Signed: 06/19/2023 03:57:25 PM


Document Has Been Signed on 06/19/2023 03:57 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: 39DATE:
06/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Jennifer WarkentinTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual/required inspection, met with Administrator Jennifer Warkentin and explained the reason for the visit. The facility has a hospice waiver for 6 and census of 39.

LPA Lund and Administrator Jennifer Warkentin toured/inspected the physical plant. LPA Lund inspected 3 resident bedrooms. The facility was found to be clean, safe, and in good repair. The facility temperature was comfortable for residents in care. There were no bodies of water present. Toxins and sharp tools were stored inaccessible to residents. Fire extinguisher, smoke detectors, and carbon monoxide detectors were found in compliance. First aid kit was complete. LPA observed centrally stored medications were locked. LPA reviewed 4 staff and 4 residents files.


The kitchen was inspected, the large freezers were inspected in were found to be in a neat and organized condition. The kitchen had the required 7- days non-perishable and 2- day perishable food supplies.

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: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023
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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