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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005324
Report Date: 07/19/2023
Date Signed: 07/19/2023 04:22:24 PM


Document Has Been Signed on 07/19/2023 04:22 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:CYPRESS ASSISTED LIVINGFACILITY NUMBER:
507005324
ADMINISTRATOR:MELINA NUNEZFACILITY TYPE:
740
ADDRESS:1801 NORTH OLIVE AVENUETELEPHONE:
(209) 410-7243
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:49CENSUS: 15DATE:
07/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Administrator Melina Nunez TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual/required inspection. LPA Lund met with Administrator Melina Nunez and explained the reason for the visit. Census 15

LPA Lund & Administrator Melina Nunez toured/inspected the physical plant, inside and outside. LPA observed notice of planned activities posted. The facility is found to be clean, safe, sanitary, and in good repair. The facility is maintained at 75 degrees F. There are no bodies of water present. Toxic substances and knives are stored inaccessible to residents. LPA observed sufficient (7) day non-perishable and (2) day perishable food supplies. Fire extinguishers (service tag September 2023), smoke detectors, and carbon monoxide detector are in compliance. First aid kit is complete. LPA reviewed resident and staff files (reviewed staff has criminal clearance). LPA observed centrally stored medications are kept inaccessible to residents.

No deficiencies cited on today's visit.

Exit interview conducted with Administrator Melina Nunez and report left.

SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023
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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