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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 10/15/2025
Date Signed: 10/17/2025 12:07:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250717103628
FACILITY NAME:COGIR OF TURLOCKFACILITY NUMBER:
502701180
ADMINISTRATOR:HERNANDEZ, JACKIEFACILITY TYPE:
740
ADDRESS:3791 CROWELL ROADTELEPHONE:
(209) 664-9500
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:100CENSUS: 70DATE:
10/15/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Pa Vang, Health and Wellness DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee did not ensure facility was maintained in good repair.
INVESTIGATION FINDINGS:
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On 10/15/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the community to close a complaint. LPA Campbell met with Pa Vang, Health and Welness Director and explained the pupose of the visit.

Regarding the allegation that the licensee did not ensure the facility was maintained in good repair, LPA Campbell interviewed staff and observed the areas of concern mentioned in the complaint. During visits on 07/13/2025 and 10/15/2025, LPA Campbell observed that the freezer was working and the temperature was at -1 degrees Fahrenheit. The ice machine chest was full and staff were seen providing ice water to residents during lunch. When LPA Campbell went into the kitchen on 10/15/2025, the temperature was comfortable and S1 reported that everything (AC, freezer and ice machine) was working.

S2 described the repairs and work arounds that were made for the AC, freezer and ice machine so that staff and residents were not unduly impacted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20250717103628
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COGIR OF TURLOCK
FACILITY NUMBER: 502701180
VISIT DATE: 10/15/2025
NARRATIVE
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 Per 87303(a), the community did "include provision of maintenance services ... for the safety and well-being of residents, employees and visitors" by providing repairs and temporary options where necessary. Therefore, based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2