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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500301453
Report Date: 11/09/2023
Date Signed: 11/09/2023 02:00:48 PM


Document Has Been Signed on 11/09/2023 02:00 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:COVENANT LIVING OF TURLOCKFACILITY NUMBER:
500301453
ADMINISTRATOR:RYAN HUSTFACILITY TYPE:
741
ADDRESS:2125 N OLIVE AVENUETELEPHONE:
(209) 632-9976
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:377CENSUS: 281DATE:
11/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Melina Nunez - Assisted Living DirectorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required annual inspection visit. LPA met with Assisted Living Director and explained the purpose of today's visit. Administrator's Certificate expires

LPA and Assisted Living Director inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen to ensure there are no safety hazards to residents . Bathrooms and bedrooms were clean and in good repair. LPA observed the first aid kit to be in compliance with the required items such as the scissors, tweezers, thermometer and guide. LPA observed required furniture, lighting and handrails throughout the facility. The hot water temperature was measured in bathroom at 110.3*F which is within the required range of 105-120*F. LPA observed two day perishables and seven day nonperishable food supplies in facility. The knives were found locked and inaccessible. Fire extinguishers last inspected on 1/18/2023. Smoke detectors are current and in compliance with fire safety. LPA observed sufficient furniture and lighting throughout the facility. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication log, all to be in order.

LPA reviewed seven resident and five 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 conducting staff training as required.

LPA received the following updated documents for community care licensing master file: LIC 308 - Designation of Administrator and copy of liability insurance.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit.

Exit interview held with Assisted Living Director. Copy of report and (LIC 811 - Confidential Names) left at facility.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
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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