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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507000962
Report Date: 02/02/2022
Date Signed: 02/02/2022 12:43:43 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: 22DATE:
02/02/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Cynthia McdanielTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jason LUnd arrived to conduct an unannounced annual/random inspection. LPA met with Administrator Cynthia Mcdaniel (certificate #6017345740 06/18/2022) and explained the purpose of the visit.

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 resident bedrooms and 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. Fire extinguishers and smoke and carbon monoxide detectors are in compliance. Fire extinguisher last serviced 09/01/2021.

LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. First aid kit was checked and is complete.

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: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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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