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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507000306
Report Date: 07/02/2024
Date Signed: 07/02/2024 03:28:57 PM


Document Has Been Signed on 07/02/2024 03:28 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:JENNIFER WARKENTINFACILITY TYPE:
740
ADDRESS:1101 E. TUOLUMNE ROADTELEPHONE:
(209) 667-8409
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:49CENSUS: 40DATE:
07/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jennifer Warkentin, AdministratorTIME COMPLETED:
03:30 PM
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On 07/02/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced to conduct a case management regarding an incident on 06/29/2024 between R1 and R2. R1 and R2 were in an altercation. When R2 fell, they hit their head and the head wound began to bleed. R2 was then taken to the hospital and R1 was arrested. As of this visit, R1 is at the Stanislaus County Jail awaiting a court date.

LPA Campbell interviewed the administrator and the staff (S1) who witnessed R2’s fall and injury. The 602’s for both clients were reviewed by LPA Campbell as well as the power of attorney.

Discharge paperwork for R2 was provided. No major injuries were identified and R2 was discharged back to the facility on 06/30/24. The responsible parties for R1 and R2 were notified by the Administrator and an SOC 341 sent to the local Ombudsman.

Administrator Warkentin provided 6 days worth of medication to R1's responsible party for use at the Stanislaus County Jail where R1 resides.

No deficiencies cited as a result of today's visit. An exit interview was conducted with Administrator Warkentin and a copy of this report was left.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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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