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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002052
Report Date: 02/04/2025
Date Signed: 02/04/2025 01:19:20 PM

Document Has Been Signed on 02/04/2025 01:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ESKATON VILLAGE ROSEVILLEFACILITY NUMBER:
315002052
ADMINISTRATOR/
DIRECTOR:		HILL, ADAMFACILITY TYPE:
740
ADDRESS:1650 ESKATON LOOPTELEPHONE:
(916) 789-7831
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 125TOTAL ENROLLED CHILDREN: 0CENSUS: 91DATE:
02/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Business Office Manager- Kay DeVaultTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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On 02/04/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a case management visit. LPA met with Business Office Manager Kay DeVault and explained the purpose of the visit.

The purpose of the visit is to gather additional information regarding an unusual incident/injury report that was sent to Community Care Licensing (CCL) on 01/27/2025. The report indicates that Resident #1 (R1) was being financially abused by the nail salon services for about a year.

During LPA interview with the Business Office Manager it was revealed that the facility did file a police report. Interview further revealed that when it comes to the nail salon services the facility has an outside vendor that comes in about twice a week to provide services to residents. These services are only provided if the resident is signed up for them. At this time the facility has suspended those services with the vendor.

Additionally, LPA gathered pertinent documents relevant to the incident.

At this time, deficiencies are not being cited.

Exit interview conducted and a copy of the report was left at the facility.



Laura MunozTELEPHONE: (916) 263-4743
Cheyenne RatajczakTELEPHONE: (916) 969-7879
DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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