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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701594
Report Date: 09/03/2026
Date Signed: 09/03/2026 04:42:45 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/03/2026 04:42 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:TURLOCK RESIDENTIALFACILITY NUMBER:
502701594
ADMINISTRATOR/
DIRECTOR:		PUNNI, MANISHAFACILITY TYPE:
740
ADDRESS:1101 E TUOLUMNE RDTELEPHONE:
(209) 667-8409
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY: 49CENSUS: 47DATE:
09/03/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Manisha PunniTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst, LPA, Noel Wolf Petersen Arrived unannounced to the facility, to conduct a annual inspection. LPA met with administrator Manisha punni to explain the purpose of the visit.

Physical inspection was conducted:

Kitchen was in good repair, LPA noted the presence of insect traps and asked for the 6 most recent pest control summary reports. There is adequate storage for 2 days perishable and 7 days non perishable foods. the menu to day is tacos. in interview, designated executive Chef gave the statement they have adequate resources to meet the needs of the clients, including menu planning authority and material requisition.

Facility has some lingering malodorus smells related to incontinence care in some rooms, staff were seen cleaning the area, and further walkthough by the LPA elimitated the odors. in interview maintience director gave the statement they have adequate resources to meet the needs of the client, including staff, hours, and material requisition.

Med room was inspected, regarding client medications and documentation procedure. interview with medtech staff indiated the facility process for documenting refusal should include more fields, as to the reason for the refusal. PRN/controlled substance, destruction record documentation was adequate.

Exterior of the facility has adequate space for activities, there are no obvious trip hazzards. LPA noted there is no evacuation route gate, virtually every bedroom room has a sliding glass door that could be used in an emergency and the campus opens out to an area that doesn't have a fully enclosed perimiter fence

Continued on c page.
Liza King
Noel Wolf Petersen
DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: TURLOCK RESIDENTIAL
FACILITY NUMBER: 502701594
VISIT DATE: 09/03/2026
NARRATIVE
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 LPA interviewed 4 residents, 1 refused. 1 client made an observation that they were being restrained inappropriately. 1 client made an observation they were needing some personal hygiene items(q tips, wet wipes, etc). 1 client made an observation that they had not showered in two weeks. Facility provided a statement that they would reassess the client files for inapproprite use of restraint, the personal hygine items that were a part of the basic services would be delivered immediately and arrangements would be made to enable the client to be able to purchase any additional items, and the facility had recently aquired and assemebled a shower chair for the resident, and a shower would be immediately scheduled. LPA observed the facility address the concerns appropritely. The LPA observed at least 1(r2) client without the ability to rotate in bed, indicating she meets the titlle 22 definition of bedridden status.

To the LPA's observation of these events, the LPA gave guidance these events could indicate quality or quantity issue in the care staff. Staff should be responsive to a basic need like assistance with leaving the bed temporarily, or supplying basic hygine items as necessary, or prioritizing a two weeks late shower when the new shower assembly is complete. The administrator should be constantly assessing staff for competency, and residents for needs being met.

LPA reviewed 5 client files, 1 hospice care plan. there are significant concerns regarding the facility documentation. three(r1,r2,r5) clients have fall risks identified on thier medical assessment charting without addressing those needs in the care plan. one(r5) client is a VMRC client who is out of scope for the facility. none(0 out of 5) of the clients have a rail order and 2 of 5 have beds equiped with half rails. LPA gave guidance a medication crush order should always be followed with a camoflauge consent form, r1 appears not to have a consent while having a crush meds order in thier hospice care plan.

LPA gave guidance the client files need to be self-audited, to determine if the facility has addressed needs of the clients, and for a determiniation if they are within the scope of the facilities license. beyond the VMRC client(r5), at least one client (r2) appears to have significant trouble repositioning (r2) to the observation of the LPA. is remarked on her 602 to be both "bed bound" and require "total support" with repositioning in bed. LPA asked the facility to coordinate with the VMRC about a plan for submitting an exemption to the facilitys client type regarding the client(r5).

LPA reviewed 5 staff files for health screenings, backround checks, current and prejob training, and first aid certificates, all files presnnt and up to date.

Administrator file was not reviewed. LPA asked for a copy of thier hiv training, the facility license, the facility certificate, the facility sketch, proof of the liability and workers comp insurances, LIC 610 to be sent the LPA's email (noel.wolfpetersen@dss.ca.gov)

1 citation was issued, a 500 $ civil pentality was also issued were given as part of this visit. a copy of the report was read and given to the administrator. appeal rights were provided. exit interview conducted.
NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Noel Wolf Petersen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/03/2026 04:42 PM - It Cannot Be Edited


Created By: Noel Wolf Petersen On 09/03/2026 at 04:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TURLOCK RESIDENTIAL
FACILITY NUMBER: 502701594

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2026
Section Cited
CCR
87272(a)(2)

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87202 Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, (2) Bedridden
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Facility will develop a plan to become fire cleared and submit it to the LPA tomorrow 9/4/26. if the facility choses to become firecleared by updating the fire clearance to include bedridden, the LPA will be informed at steps of the process of updates to the plan on a monthly basis.
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not following this requirement is evidinced by 1 or more persons in the facility not being able to rotate indepentantly(r2) to the observation of the LPA, 602 indicates mixed status of nonamb and requiring assistance with rotation.

not following this requirement poses a risk to the health saftey and personal rights of clients in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Liza King
NAME OF LICENSING PROGRAM MANAGER:
Noel Wolf Petersen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2026


LIC809 (FAS) - (06/04)
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