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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005673
Report Date: 05/12/2022
Date Signed: 05/12/2022 12:57:04 PM


Document Has Been Signed on 05/12/2022 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:TRINITY VALLEY CAREFACILITY NUMBER:
507005673
ADMINISTRATOR:TRINIDAD, JOANNEFACILITY TYPE:
740
ADDRESS:242 S LAUREL STTELEPHONE:
(209) 678-4489
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:15CENSUS: 10DATE:
05/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Joanne TrinidadTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jason Lund conducted an unannounced visit today to do an annual/required inspection, LPA Lund met with Administrator Joanne Trinidad and explained the reason for the visit. Currently 10 residents at this time.

LPA Lund & Administrator Joanne Trinidad walked the interior and the exterior of the facility. A tour of the common living spaces, resident bedrooms and bathrooms were conducted. In addition, a tour of the activity rooms, medication storage, and kitchen are was conducted. A tour of the garage and outdoor areas was conducted. Resident bedrooms were observed to be clean and in good repair at this time. There was a locked storage for medications which was observed to be inaccessible to the residents at this tine. Food supply was adequate for 2-day perishable and 7-day nonperishable quantities.

Fire extinguishers were set to expire on 10/09/2022 and observed to be in compliance at this time. Smoke alarms are operational. This facility home had a carbon monoxide detector and observed to in compliance at this time. First Aid kit was on site and did contain all required components. Toxins were observed to be locked and made inaccessible to the residents at this time

No deficiencies were observed and cited during today’s annual/required inspection.

Exit interview conducted with Administrator Joanne Trinidad and copy of report left at facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
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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