<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507000962
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:29:53 PM

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:LIFESPRING SENIOR CAMPUS, A WELLNESS COMMUNITYFACILITY NUMBER:
507000962
ADMINISTRATOR:CYNTHIA MCDANIELFACILITY TYPE:
740
ADDRESS:936 GEER ROADTELEPHONE:
(209) 634-7764
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:40CENSUS: 21DATE:
12/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cynthia McdanielTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Anthony Tuck arrived to conduct an unannounced annual/random inspection on 12/17/2021. LPA met with staff Cynthia Mcdaniel and explained the purpose of the visit. Cynthia Mcdaniel is the Administrator and holds certificate #6017345740 that expires on 06/18/2022.

This facility has 4 single story buildings and is licensed to serve forty (40) residents of which 29 may be non-ambulatory facility has a hospice waiver to serve 2 residents. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at (114) degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 09/01/2021 Thermostat observed at (77) degrees Fahrenheit.

LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed resident and staff roster. LPA reviewed staff associations to the facility. First aid kit was checked and is complete.

The following forms need updating and were received during the inspection on 12/20/2021:
LIC 308, LIC 500, LIC 610, LIC 9020, copy of liability insurance, Administrator certificate.

No deficiencies were cited during today's inspection. Exit interview held with Cynthia Mcdaniel and a copy of report given at the conclusion of the visit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2