315002052-8-31-2023-59-AS-KHOS-CVLKFL-20230912075206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002052
Report Date: 08/31/2023
Date Signed: 08/31/2023 03:40:09 PM

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
06/06/2023 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20230606163003

FACILITY NAME:	ESKATON VILLAGE ROSEVILLE		FACILITY NUMBER:	315002052
ADMINISTRATOR:	HILL, ADAM		FACILITY TYPE:	740
ADDRESS:	1650 ESKATON LOOP		TELEPHONE:	(916) 789-7831
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	125	CENSUS: 99	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Adam Hill, Administrator		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff do not attend to residents in a timely manner
Staff do not provide proper food service to residents in care
Staff are unable to meet resident care needs
Facility doors pose a hazard to residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with Adam Hill during today’s inspection.
LPA investigated allegation “Staff do not attend to residents in a timely manner”. LPA interviewed residents and staff and conducted a file a review. LPA interviewed 7 residents, in which they all stated the staff are quick to respond to their care needs. Residents stated on occasion it may take longer then normal but all staff are responsive. LPA interviewed care staff in which all staff stated they work together as a team, so if the assigned caregiver cannot respond to resident’s care light quickly, a different care staff will help.
Continuation on 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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 59-AS-20230606163003

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 ROSEVILLE	FACILITY NUMBER: 315002052
	VISIT DATE: 08/31/2023

NARRATIVE

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Care staff stated at times it may take a bit longer to respond if all caregivers are providing care to different residents, but it is never for an extended amount of time. Due to the information gathered LPA finds allegation to be UNFOUNDED.
LPA investigated allegation “Staff do not provide proper food service to residents in care”. LPA interviewed residents and staff and conducted a file a review. LPA interviewed 7 residents, in which they stated at times they get food delivered to their rooms and they always receive their food. At times the food can be cold, but they are able to reheat the food. LPA interviewed care staff in which they stated the kitchen staff make the food and then inform them when the food is ready for delivery. Caregivers pick up the food and delivery it to the resident rooms. Care staff stated they are unaware of a time when residents did not get their food delivered and residents were without a meal. LPA interviewed the Food Service Director, in which they stated residents are never without a meal. Kitchen informs care staff when food is ready for delivery and then care staff delivery the food to resident rooms. Medication technicians then check the meal tickets and verify that all residents have had their meal. Due to the information gathered LPA finds allegation to be UNFOUNDED.
LPA investigated allegation, “Staff is unable to meet resident care needs”. LPA interviewed residents and staff and conducted a file a review. LPA interviewed 7 residents, in which they stated their care needs are met by the facility staff. Residents did not have an issue with receiving the proper care. LPA interviewed care staff in which they stated they are able to meet the needs of the residents. All care staff stated they are staffed correctly and there has been no issues with resident’s receiving the proper care. LPA interviewed care staff in which all staff stated they work together as a team, so if the assigned caregiver cannot respond to resident’s care light quickly, a different care staff will help. Due to the information gathered LPA finds allegation to be UNFOUNDED.

Continuation on 9099-C.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 59-AS-20230606163003

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 ROSEVILLE	FACILITY NUMBER: 315002052
	VISIT DATE: 08/31/2023

NARRATIVE

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LPA investigated allegation, “Facility doors pose a hazard to residents in care”. LPA interviewed staff and residents in care. LPA interviewed Director of Environmental Services in which he stated there have been complaints that the doors are heavy to open and that they don't like the self-latching doors. Director stated the fire department requires the self latching doors and that facility has been instructed they are not able to use door stoppers. LPA interviewed residents in care which all stated they have had no issues with the facility doors. Due to the information gathered LPA finds allegation to be UNFOUNDED.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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