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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097001275
Report Date: 04/07/2021
Date Signed: 04/07/2021 01:39:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ESKATON LODGE CAMERON PARKFACILITY NUMBER:
097001275
ADMINISTRATOR:TOPPING, MARNAFACILITY TYPE:
740
ADDRESS:3421 PALMER DRTELEPHONE:
(530) 672-8900
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY:60CENSUS: 25DATE:
04/07/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Marna ToppingTIME COMPLETED:
01:45 PM
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Case management visit regarding staff S1 (See Confidential Names List - LIC 811) Licensing Program Analyst (LPA) Smith and LPA Wolter delivered, in person, an immediate exclusion order, dated April 4,2021 for the listed individual on the LIC 811. LPAs were cleared prior to conducting in person visits, wore proper PPE, and were screened by the facility prior to entry. The identified individual has been determined to have engaged in conduct inimical as an employee in this facility.

Facility shall, immediately remove identified individual on the LIC 811 from any contact with residents and he may not be physically present in any licensed care facility heretoforthwith.

Executive Director (ED) Marna Topping stated that S1 has already been terminated and she understands the individual is not to be present at the facility.

No deficiencies were cited as a result of today's visit. Exit interview conducted and copy of report left at facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael SmithTELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021
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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