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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
507000962
Report Date:
01/18/2024
Date Signed:
01/19/2024 08:11:12 AM
Document Has Been Signed on
01/19/2024 08:11 AM
- 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:
LIFESPRING SENIOR CAMPUS, A WELLNESS COMMUNITY
FACILITY NUMBER:
507000962
ADMINISTRATOR:
CYNTHIA MCDANIEL
FACILITY TYPE:
740
ADDRESS:
936 GEER ROAD
TELEPHONE:
(209) 634-7764
CITY:
TURLOCK
STATE:
CA
ZIP CODE:
95380
CAPACITY:
40
CENSUS:
18
DATE:
01/18/2024
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Cynthia McDaniel, Administrator
TIME COMPLETED:
01:00 PM
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SUPERVISOR'S NAME:
Lisa Rios
TELEPHONE:
(916) 969-9685
LICENSING EVALUATOR NAME:
Renee Campbell
TELEPHONE:
(916) 206-6380
LICENSING EVALUATOR SIGNATURE:
DATE:
01/19/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/19/2024
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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