097005046-6-8-2021-27-AS-MSEY-C3TNP2-20210609103733

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097005046
Report Date: 06/08/2021
Date Signed: 06/08/2021 12:33:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/26/2020 and conducted by Evaluator Michael Smith

COMPLAINT CONTROL NUMBER: 27-AS-20200326160237

FACILITY NAME:	ESKATON VILLAGE PLACERVILLE		FACILITY NUMBER:	097005046
ADMINISTRATOR:	MCGRATH, EVELYN		FACILITY TYPE:	740
ADDRESS:	3380 BLAIRS LN		TELEPHONE:	(530) 295-3400
CITY:	PLACERVILLE	STATE: CA	ZIP CODE:	95667
CAPACITY:	74	CENSUS: 46	DATE:	06/08/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Evelyn McGrath		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident left in soiled diapers

Staff are not meeting the needs of residents in care

Resident sustained bruises due to negligence

Lack of supervision resulting in resident pushing another resident

INVESTIGATION FINDINGS:

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Prior to entering the facility, LPA Smith spoke with staff to pre-screen that the facility is COVID free. Analyst also self-screened for having no known symptoms or exposure. Analyst followed facility's screening protocols, wore an N-95 respirator and maintained distance during the visit. LPA Smith conducted an unannounced complaint visit and met with Evelyn McGrath.

Allegations:
Resident left in soiled diapers
Complainant stated that on a visit, it was noticed that resident's diaper was full and not changed. Staff was notified and the briefs were promptly changed. Facility management stated that they immediately changed the brief and there was no redness noted, which would indicate that the brief was not changed for a period of time. There is no evidence that resident was left in soiled diapers for an extended amount of time. Based on this, the allegation is UNSUBSTANTIATED

See 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael Smith	TELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20200326160237

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ESKATON VILLAGE PLACERVILLE	FACILITY NUMBER: 097005046
	VISIT DATE: 06/08/2021

NARRATIVE

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Staff are not meeting the needs of residents in care
Allegation that facility is not meeting he needs of resident's in care as there are only 1 staff per 10 residents and a resident room had clothing out . A staff ratio of 1/10 and clothes left out is not p[rima facie evidence that the resident's needs are not being met. According to management, rooms are cleaned daily and linen is changed as needed. There is no other evidence that resident's needs are not being met. Based on this, the allegation is UNSUBSTANTIATED.

Resident sustained bruises due to negligence
It was noted on 3/16/20 on hospice care notes that there was bruising on the left wrist and elbow. No distress noted. Management noted that there is no SIR around that time frame and no known causation for the bruising. Although the complaint is alleging negligence, there is no evidence to support that assertion. Based on this, the allegation is UNSUBSTANTIATED

Lack of supervision resulting in resident pushing another resident
A resident was observed pushing a walker into another resident, R2 while watching a movie. Complaint alleges that this is a lack of supervision and was witnessed by 3rd party. According to Evelyn McGrath, there is no documented incident where this occurred which resulted in the injury of R2 and this was never brought to the attention of staff or management. Based on this, the allegation is UNSUBSTANTIATED

As a result of this investigation, LPA finds the allegations that resident left in soiled diapers, staff are not meeting the needs of residents in care, resident sustained bruises due to negligence and lack of supervision resulting in resident pushing another resident to be UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael Smith	TELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC9099 (FAS) - (06/04)

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