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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097005046
Report Date: 05/05/2021
Date Signed: 05/05/2021 04:39:27 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 VILLAGE PLACERVILLEFACILITY NUMBER:
097005046
ADMINISTRATOR:MCGRATH, EVELYNFACILITY TYPE:
740
ADDRESS:3380 BLAIRS LNTELEPHONE:
(530) 295-3400
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY:74CENSUS: 49DATE:
05/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Evelyn McGrath, Executive DirectorTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Wolter contacted the facility by phone on 05/05/2021 due to COVID-19 and precautionary measures to conduct a case management visit regarding a SOC 341 Community Care Licensing (CCL) received on 05/03/2021. LPA spoke to Executive Director (ED) Evelyn McGrath and explained the purpose of the phone call.

LPA and ED discussed the details of the SOC 341 and LPA asked if the resident (R1) has made any further allegations, ED stated that R1 has not made any further allegations and tells staff that they are happy at the facility. LPA obtained copy of the police report case number and requested ED send a copy of R1's 602 to CCL by 05/06/2021.

No deficiencies are being cited at this time, further follow up may be needed.

Exit interview conducted, copy of report emailed to ED; ED to sign report and return to CCL by either fax, email, or USPS. A signed copy should also be retained for facility records.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Danyle WolterTELEPHONE: (916) 708-5307
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021
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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