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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005628
Report Date: 03/12/2026
Date Signed: 03/12/2026 03:47:21 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
02/19/2026 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260219102741
FACILITY NAME:ESKATON LODGE GRANITE BAYFACILITY NUMBER:
317005628
ADMINISTRATOR:KAY DEVAULTFACILITY TYPE:
740
ADDRESS:8550 BARTON RDTELEPHONE:
(916) 789-0326
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:118CENSUS: 77DATE:
03/12/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Alicia Rist, Regional Director of OperationsTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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-Facility staff are not answering communications from resident’s family
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Regional Director of Operations, Alicia Rist, to deliver complaint investigation findings regarding the above stated allegation.

During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation.


***********************************************Continued on LIC9099-C************************************************
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
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 3
Control Number 59-AS-20260219102741
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 LODGE GRANITE BAY
FACILITY NUMBER: 317005628
VISIT DATE: 03/12/2026
NARRATIVE
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Interviews with the Resident Care Director (RCD) and former Executive Director (ED), Kay Devault, indicated that they have not had any voice messages from any other family members of resident (R1). The former ED indicated that they provided their cell phone number to family members of residents at the care home, so they can contact the ED anytime. Interview with staff (S1) indicated that they have only heard of and seen R1's responsible party and were not aware of any other family members. Interviews with RCD, S1, and former ED indicated that the facility communicated frequently with R1's responsible party. Interview with R1's responsible party indicated that they were at the facility almost everyday and communicating with facility staff.

Based on interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited.
Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
02/19/2026 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260219102741

FACILITY NAME:ESKATON LODGE GRANITE BAYFACILITY NUMBER:
317005628
ADMINISTRATOR:KAY DEVAULTFACILITY TYPE:
740
ADDRESS:8550 BARTON RDTELEPHONE:
(916) 789-0326
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:118CENSUS: 77DATE:
03/12/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Alicia Rist, Regional Director of OperationsTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Facility staff did not properly report incident
INVESTIGATION FINDINGS:
1
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3
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5
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7
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9
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11
12
13
Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Regional Director of Operations, Alicia Rist, to deliver complaint investigation findings regarding the above stated allegation.
According to resident (R1's) Death Report LIC624A, R1's responsible party was notified on the date of the incident, January 5, 2026. CCLD received a copy of the report on January 10, 2026. Interviews with the Resident Care Director (RCD) and staff (S1) indicated that the facility notified R1's responsible party, who is listed on R1's Face Sheet as the emergency contact/resident representative, of R1's passing. R1s emergency contact/resident representative is also listed on R1's Advance Health Care Directive as R1's
primary agent. Interview with R1's responsible party indicated that they were notified of R1's passing.
Based on records reviewed and interviews conducted, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. No deficiencies are being cited. Exit interview conducted. A copy of report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
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 3