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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507000962
Report Date: 01/18/2024
Date Signed: 01/18/2024 12:57:41 PM


Document Has Been Signed on 01/18/2024 12:57 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: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: 18DATE:
01/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cynthia McDaniel, AdministratorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced annual inspection on 01/18/2024 at approximately 9:30 am. LPA met with Cynthia McDaniel, Administrator and explained the purpose of the visit. Administrator McDaniel reported that there were 16 care staff and 18 residents.

This facility is a senior residential facility with a majority of ambulatory, independent residents. Upon entry, LPA Campbell observed signage for guests to be aware of any COVID symptoms before entering. Throughout the facility, several SEE Something, SAY Something 4' X 3' posters were observed. LPA Campbell inspected the physical plant including but not limited to kitchen, recreation room, bathrooms and a patio area. Main exits to residents rooms either lead out to an interior hallway or to the outdoors. LPA observed sufficient furniture and lighting throughout the program.

The food pantry in the kitchen and in the basement was observed to be sufficient to feed clients for 7 days and there was enough fresh foods to feed clients for 3 days. Sharps were observed to be in a locked box under the sink. Two resident files were reviewed. A corkboard in the kitchen displayed a list of residents and their special diets. Menus and calendared client appointments were also attached to the board. A fire extinguisher was observed on the main floor and in the basement and had last been inspected on 08/28/2023.

Per California Code of Regulations, Title 22 Division 6, Chapter 8 and Health and Safety Code, No Deficiencies were cited during this visit.
Exit interview held and a report given at the conclusion of the inspection.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
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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