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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507000962
Report Date: 02/22/2023
Date Signed: 02/22/2023 12:46:16 PM


Document Has Been Signed on 02/22/2023 12:46 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: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: 19DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Cynthia McDanielTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual/required inspection. LPA met with Administrator Cynthia McDaniel (certificate #6017345740 06/18/2024) and explained the purpose of the visit.

LPA Lund and Administrator Cynthia McDaniel toured/inspected the facility which 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 09/30/2022.

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 left.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023
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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