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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507002685
Report Date: 06/29/2022
Date Signed: 06/29/2022 02:10:58 PM


Document Has Been Signed on 06/29/2022 02:10 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: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: 37DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Office Manager Dawn PeroTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above address to conduct an annual/required annual Inspection. LPA Lund met with Office Manager Dawn Pero and explained the reason for the visit. The facility maintains a fire clearance for secured perimeter and can provide hospice care for up to 8 residents. The facility is approved for 56 non-ambulatory residents. The facility census is approximately 34.

LPA Lund and Office Manager Dawn Pero walked the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room, and outdoor areas. There are no bodies of water present in the facility at this time. LPA observed some rooms and they are equipped with the required furniture and sufficient lighting throughout the facility.

LPA observed sufficient seven-day non-perishable and two-day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. LPA observed centrally stored medications securely stored inaccessible to residents.

LPA requests the following updated forms:
LIC 610, LIC 308, LIC 500, Copy of liability insurance, copy of plan of operation, copy of Fire clearance (form STD 850).

No deficiencies were cited on this visit. A copy of this report was left with Office Manager Dawn Pero
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
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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