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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 314700008
Report Date: 03/26/2024
Date Signed: 03/29/2024 11:56:19 AM

Document Has Been Signed on 03/29/2024 11:56 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:LIVE WELL AT HOME BY ESKATONFACILITY NUMBER:
314700008
ADMINISTRATOR:BETH NOSEWORTHYFACILITY TYPE:
300
ADDRESS:5105 MANZANITA AVETELEPHONE:
(916) 459-3220
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
03/26/2024
Required - 2 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Cynthia DriverTIME COMPLETED:
12:30 PM
NARRATIVE
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Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office Live Well at Home by Eskaton for a required 2 year on at approximately 11:00am.

Upon arrival, AGPA Vigil identified herself and was greeted by Designee, Cynthia Driver . The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review, AGPA Vigil discussed the findings of the inspection with the Designee and advised no deficiencies were found. A copy of the report was provided with appeal rights.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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Document is an Amendment of Original Document on 03/29/2024 09:27 AM


Created By: Megan Vigil On 03/26/2024 at 12:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: LIVE WELL AT HOME BY ESKATON
FACILITY NUMBER: 314700008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/02/2024
Section Cited
1796.43 (a)
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.. Home care organizations that employ affiliated... shall ensure the affiliated.. cleared on the home care aide registry...
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Proof of clearance on the Home Care Aide Registry was not documented in the personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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