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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002052
Report Date: 05/28/2025
Date Signed: 05/28/2025 02:13:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250515095816
FACILITY NAME:ESKATON VILLAGE ROSEVILLEFACILITY NUMBER:
315002052
ADMINISTRATOR:RIST, ALICIAFACILITY TYPE:
740
ADDRESS:1650 ESKATON LOOPTELEPHONE:
(916) 789-7831
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:125CENSUS: 73DATE:
05/28/2025
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:David DingcongTIME COMPLETED:
02:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure that residents' rooms are clean and sanitized.
Resident's rooms are malodorous.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with David Dingcong to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

*** Report continued on 9099-C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 709-6317
LICENSING EVALUATOR NAME: Cassandra MikkelsonTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 59-AS-20250515095816
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ESKATON VILLAGE ROSEVILLE
FACILITY NUMBER: 315002052
VISIT DATE: 05/28/2025
NARRATIVE
1
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8
9
10
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Staff do not ensure that residents' rooms are clean and sanitized.

Licensing Program Analyst (LPA) Cassandra Mikkelson toured the facility during the investigation. LPA reviewed documents pertinent to the investigation which indicated that resident’s rooms are being cleaned and maintained by staff. LPA reviewed work orders placed at the facility for maintenance like carpet and floor cleanings which indicated staff and maintenance teams were cleaning on a regular basis to keep the facility and resident rooms clean and sanitized. The allegation that staff do not ensure that resident rooms are clean and sanitized is unsubstantiated.

Resident's rooms are malodorous.

Licensing Program Analyst (LPA) Cassandra Mikkelson toured facility during investigation. LPA observed no odors in common areas and hallways. LPA toured multiple residents and observed no odors. Interviews with residents indicated that staff regularly assist with cleaning and help keep each resident’s room clean and free of odors. The allegation resident’s rooms are malodorous is unsubstantiated.

Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation 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.

Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 709-6317
LICENSING EVALUATOR NAME: Cassandra MikkelsonTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250515095816

FACILITY NAME:ESKATON VILLAGE ROSEVILLEFACILITY NUMBER:
315002052
ADMINISTRATOR:RIST, ALICIAFACILITY TYPE:
740
ADDRESS:1650 ESKATON LOOPTELEPHONE:
(916) 789-7831
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:125CENSUS: 73DATE:
05/28/2025
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:David DingcongTIME COMPLETED:
02:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's toileting needs are not being met.
Resident's hygiene needs are not being met.
Facility has mold- kitchen
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with David Dingcong to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, 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 MunozTELEPHONE: (916) 709-6317
LICENSING EVALUATOR NAME: Cassandra MikkelsonTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20250515095816
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ESKATON VILLAGE ROSEVILLE
FACILITY NUMBER: 315002052
VISIT DATE: 05/28/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Resident's toileting needs are not being met

Licensing Program Analyst (LPA) Cassandra Mikkelson toured the facility during the investigation. Interviews with Resident R1, R2, R3, and R4 indicated that they were satisfied with the care they were receiving at the facility. LPA toured four (4) resident rooms which indicated clean and sanitary environments for each resident in care. Records reviewed indicated that each resident was receiving the assistance that was listed in their needs and services plans. The allegation that resident’s toileting needs are not being met is unfounded.

Resident's hygiene needs are not being met

Licensing Program Analyst (LPA) Cassandra Mikkelson toured the facility during the investigation. Interviews conducted with residents indicated that resident’s hygiene needs are being met and there are no complaints regarding hygiene care. Records reviewed indicated that residents are receiving assistance with hygiene needs according to their care plans. LPA toured four (4) resident rooms and observed resident rooms and bathrooms were clean with no odors. The allegation that resident’s hygiene needs are not being met is unfounded.

Facility has mold

Licensing Program Analyst (LPA) Cassandra Mikkelson toured the facility during the investigation. LPA toured the kitchen area where mold was alleged. LPA observed kitchen to be clean and free of visible mold. Records reviewed indicated that staff clean multiple times daily and monitor kitchen area for any potential mold hazards. Interviews conducted indicated that kitchen staff monitor for any hazards and report to management. No mold has been observed currently by staff. The allegation that facility has mold is unfounded.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.

Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 709-6317
LICENSING EVALUATOR NAME: Cassandra MikkelsonTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4