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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005628
Report Date: 03/21/2024
Date Signed: 03/21/2024 04:06:22 PM


Document Has Been Signed on 03/21/2024 04:06 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 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: 85DATE:
03/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kristy Ashley, Resident Care CoordinatorTIME COMPLETED:
04:30 PM
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On 3/21/2024 LPA Tryon visited the facility to conduct an annual inspection. LPA met with Resident Care Coordinator Kristy Ashley. The facility currently has 85 residents.
LPA toured the facility including common areas, dining room, kitchen, food storage/ coolers, chemical storage, medication rooms, resident rooms/apartments, bathrooms, outside areas.
The facility is large, clean and nicely furnished. There are various areas available for activities. The dining room is large and spacious. LPA toured the kitchen and storage, Food supplies appear more than adequate to meet the requirement of 2 days perishable supplies and 7 days non-perishable. Food appeared to be stored appropriately, food appears to be varied and of good quality. The facility is working with the resident counsel to come up with a menu that is enjoyed by the residents and healthy. LPA toured 6 resident rooms. Rooms are spacious and nicely decorated and clean. Bathrooms are clean with functional plumbing in good condition.
The facility appears to have various activities for residents to participate in. LPA interviewed 3 residents and spoke with several others. Residents interviewed seemed to be comfortable and enjoy living at the facility. LPA interviewed 3 staff who appeared knowledgeable about the facility and procedures.
LPA reviewed 5 resident files and 4 staff files. Files included required documents.
LPA reviewed the CARE Tool with Ms. Ashley.
At this time the facility appears to be in substantial compliance with the regulations.

No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
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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