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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507004751
Report Date: 05/01/2024
Date Signed: 05/01/2024 03:05:26 PM

Document Has Been Signed on 05/01/2024 03:05 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:TURNER RESIDENTIAL CAREFACILITY NUMBER:
507004751
ADMINISTRATOR/
DIRECTOR:
TURNER, WILL J.FACILITY TYPE:
735
ADDRESS:613 FLOYD AVENUETELEPHONE:
(209) 522-5600
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 12CENSUS: 11DATE:
05/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator Will TurnerTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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LPA Jason Lund made an unannounced visit to conduct an annual/required inspection. LPA Lund met with Administrator, Will Turner and explained the reason for the visit. Census: 11

LPA Lund & Will Turner inspected/toured the facility. LPA observed the interior, and the exterior of the facility were inspected including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were checked and found in good working order. Carbon Monoxide detector was found in good working order. All residents are ambulatory. LPA checked medications and found medications are being dispensed as ordered.

LPA reviewed a 3 resident and 2 staff records. Resident files were found to be complete and current A review of staff records indicates that all facility staff have received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates. Facility is conducted staff training as required.

No deficiencies were observed at the time of the visit. Exit Interview and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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