097005046-5-16-2023-25-AS-LMUZ-CRVTK7-20230516144724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097005046
Report Date: 05/16/2023
Date Signed: 05/16/2023 10:38:58 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/16/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 25-AS-20230216114919

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: 57	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Evelyn McGrath		TIME COMPLETED:	10:55 AM

ALLEGATION(S):

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Staff did not ensure that resident takes medication as prescribed.

INVESTIGATION FINDINGS:

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On 5/16/23, Licensing Program Analysts (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Evelyn McGrath .

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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 25-AS-20230216114919

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ESKATON VILLAGE PLACERVILLE	FACILITY NUMBER: 097005046
	VISIT DATE: 05/16/2023

NARRATIVE

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Staff did not ensure that resident takes medication as prescribed.
During the course of the investigation the department obtained facility documentation, conducted interviews, and inspected facility grounds. The department reviewed 5 resident MARs for January and February, LIC 602 Physician Report, PRN Authorization Letter, Medication Reasons for Use, and Medication Training Certification. Through interviews, there was no indication that residents were not receiving their medication as prescribed. Through review of documentation, the LPA could not find evidence that medication was not given as prescribed, and it appeared there was no evidence proving that medication was not being logged in correctly. Through observation and interview the LPA finds this allegation to be UNFOUNDED - meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview was conducted with Administrator Evelyn McGrath and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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