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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005628
Report Date: 02/02/2023
Date Signed: 02/02/2023 03:30:14 PM


Document Has Been Signed on 02/02/2023 03:30 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ESKATON LODGE GRANITE BAYFACILITY NUMBER:
317005628
ADMINISTRATOR:DELGADO, KIMBERLY (KIM)FACILITY TYPE:
740
ADDRESS:8550 BARTON RDTELEPHONE:
(916) 789-0326
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:118CENSUS: 86DATE:
02/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Kim DelgadoTIME COMPLETED:
03:45 PM
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LPA Parks and AGPA Walker-Flores arrived on Thursday February 2, 2023 to conduct the annual inspection. Both were screened in the lobby of the facility and were wearing the following Personal Protective Equipment (PPE) was worn: N-95 mask and KN95.

During today's annual inspection, the full CARES tool was used. LPA Parks and AGPA Walker-Flores reviewed resident and staff files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. Administrator Kim, LPA Parks and AGPA Walker-Flores toured the facility together to ensure the health and safety of residents in care. The areas toured included resident apartments, kitchen, hallways, activity room, and courtyard. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
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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