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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
097001275
Report Date:
03/03/2021
Date Signed:
03/03/2021 02:50:19 PM
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:
ESKATON LODGE CAMERON PARK
FACILITY NUMBER:
097001275
ADMINISTRATOR:
TOPPING, MARNA
FACILITY TYPE:
740
ADDRESS:
3421 PALMER DR
TELEPHONE:
(530) 672-8900
CITY:
CAMERON PARK
STATE:
CA
ZIP CODE:
95682
CAPACITY:
60
CENSUS:
25
DATE:
03/03/2021
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Marna Topping
TIME COMPLETED:
03:00 PM
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Case management visit regarding an incident that was submitted via SOC 341. The incident involved a resident and a facility staff member. See LIC 812 for confidential details.
SUPERVISOR'S NAME:
Laura Munoz
TELEPHONE:
(916) 263-4743
LICENSING EVALUATOR NAME:
Michael Smith
TELEPHONE:
(916) 206-7807
LICENSING EVALUATOR SIGNATURE:
DATE:
03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/03/2021
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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