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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507002685
Report Date: 09/17/2021
Date Signed: 09/17/2021 03:53:12 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:ST. FRANCIS ASSISTED CAREFACILITY NUMBER:
507002685
ADMINISTRATOR:JAMI YOUNGFACILITY TYPE:
740
ADDRESS:120 TWENTIETH CENTURY BLVDTELEPHONE:
(209) 668-8014
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:56CENSUS: 32DATE:
09/17/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tej Dhillon/Licensee RepresentativeTIME COMPLETED:
02:15 PM
NARRATIVE
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An office meeting was held on this day via Teams. Present in the meeting were Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Stephenie Doub, Program Clinical Consultant (PCC) Christina Wong, Licensee Representative Tej Dhillon and Sat Dhillon.
The purpose of the meeting was to discuss recent COVID outbreak, mitigation measures, staff training and designation of an administrator. A tour was completed virtually to observe designated isolation rooms. It was recommended that the licensee place trash cans in each isolation room and outside of the isolation rooms to allow for proper donning and doffing of PPE. It was also recommended that carts be placed outside of each isolation room with PPE and posters demonstrating proper donning and doffing techniques. The facility has designated staff to care for COVID positive residents. A staff member was asked to demonstrate proper donning and doffing of PPE, which was observed. On 9/16/2021, Local Public Health provided donning and doffing training to staff present at the facility. Staff were scheduled to be fit tested on 9/22/2021. All residents were COVID tested using antigen testing on 9/16/2021 with negative results. Staff were to be tested on this day 9/17/2021. PCR testing was scheduled for 9/21/2021. It was also recommended that signage be placed in the elevator limiting only 2 persons in the elevator to encourage social distancing.
The licensee reported that they have a designated an Infection Preventionist (IP). The RO provided information for training for the IP through the CDC. The licensee was reminded that a line list need to be provided to the RO daily prior to the daily call. The line list needs to have all resident and staff names, date of birth, vaccination status, date of vaccination, type of vaccine, test dates and results. The Licensee informed the RO that they have hired an Administrator for the facility, but it was learned that this person currently does not hold a valid Administrator's Certificate. The Licensee was reminded that a person with a valid certificate needs to be present 40 hours at this time.
The following deficiency was cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided via email to Licensee Rep. Tej Dhillon.
SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2021
Section Cited

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87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator...and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility...
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This regulation was not met as evidenced by:
The licensee did not ensure that the facility had a currently certified administrator. Based on information provided, the adminstrator was teminated, and no person with a valid certificate is managing the facility. This poses a risk to residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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