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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507000306
Report Date: 10/08/2024
Date Signed: 10/08/2024 01:18:26 PM

Document Has Been Signed on 10/08/2024 01:18 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:COVENANT CARE-TURLOCK RESIDENTIALFACILITY NUMBER:
507000306
ADMINISTRATOR/
DIRECTOR:		JENNIFER WARKENTINFACILITY TYPE:
740
ADDRESS:1101 E. TUOLUMNE ROADTELEPHONE:
(209) 667-8409
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 49CENSUS: DATE:
10/08/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Jennifer Warkentin, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 10/08/24, Licensing Program Analyst Renee Campbell arrived unannounced to the facility. LPA Campbell was met by Administrator Jennifer Warkentin and explained the purpose of the visit.

On 10/04/24, a report was received regarding a possible scabies infestation. LPA Campbell reviewed the incident report database and found no UIR's reporting scabies from the facility. LPA Campbell contacted the facility by phone and asked Administrator Warkentin if any of the residents had scabies, were currently in isolation or if any of them had a diagnoses of any infection before. The administrator stated no. LPA Campbell then entered and conducted a tour of the facility and observed clients laying in bed, watching TV and socializing.

The facility was free of odor and pathways were unobstructed. Residents were observed eating lunch in the dining room. LPA Campbell spoke to a resident walking down the hall. When asked what they had for lunch, the client stated they had steak cubes on pasta and chocolate pudding. The administrator's certification was reviewed. Certificate number 7024856740 was displayed in the facility and expires on 3/16/26.

LPA Campbell consulted with the administrator to ensure all medical emergencies, falls and med errors are recorded via incident report.

The facility is in compliance with Title 22 Regulation, and no deficiencies were cited. An exit interview was conducted, and a copy of this LIC 809 report were provided to the facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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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