317005628-5-3-2022-25-AS-KHOS-CEASWW-20220510141500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 317005628
Report Date: 05/03/2022
Date Signed: 05/03/2022 04:02:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/03/2022 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 25-AS-20220103144150

FACILITY NAME:	ESKATON LODGE GRANITE BAY		FACILITY NUMBER:	317005628
ADMINISTRATOR:	DELGADO, KIMBERLY (KIM)		FACILITY TYPE:	740
ADDRESS:	8550 BARTON RD		TELEPHONE:	(916) 789-0326
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	118	CENSUS: 91	DATE:	05/03/2022
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Kim Delgado, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff failed to assist resident in a timely manner
Insufficient staffing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived at the facility unannounced to continue investigation into complaint. LPA met with Facility Administrator, Kim Delgado and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they used hand sanitizer shortly after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Receptionist.
LPA investigated allegation, "Staff handled resident in a rough manner". LPA interviewed 6 care staff, in which all care staff stated they have not observed staff handling residents in a rough manner. LPA interviewed 3 residents in care, in which 2 of 3 stated staff have never been rough with them during care or any other time.

Continuation on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

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 25-AS-20220103144150

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ESKATON LODGE GRANITE BAY	FACILITY NUMBER: 317005628
	VISIT DATE: 05/03/2022

NARRATIVE

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LPA interviewed 1 resident in which they stated there have been a few times that staff have been rough during care unintentionally. Resident stated some staff can have attitudes toward them when providing care. Resident was unable to remember staff names or details. Due to the information gathered, LPA finds allegation to be UNSUBSTANTIATED.
LPA investigated allegation, "Staff failed to assist resident in a timely manner". LPA interviewed residents and staff and reviewed facility documentation. Facility has a call light system, and when residents require help they push their pendant which alarms the caregiver pager and a computer in the medication room. LPA interviewed 6 care staff in which they stated residents do not wait more than 15 minutes once pressing the pendant. Care staff stated if the assigned caregiver is unavailable to respond then other caregivers or med techs will respond to the call light. The computer in the medication room continues to signal until a caregiver responds to the pendant push and clears the call. Interviews indicated that staff do not have residents waiting over 20 minutes when responding to a pendant pushes. LPA interviewed 3 residents in care, in which they stated most the time staff respond in a timely manner to their pendant push. On occasion residents may wait for longer periods of time. Relevant party indicated residents can wait up to 45-60 minutes for staff to respond. Due to the information gathered, LPA finds allegation to be UNSUBSTANTIATED.
LPA investigated allegation that facility has, "Insufficient staffing". LPA interviewed residents, staff, and reviewed facility documentation. LPA interviewed staff in which they stated AM shift has 4 caregivers and 2 med techs, PM shift has 2 to 3 caregivers and 2 med techs, and NOC shift has 2 caregivers and 1 med tech on the floor. Care staff indicated that due to covid related issues, at times it was hard finding and hiring staff. Facility used a caregiver agency to supplement care when they were shorthanded. Care staff indicated they are able to meet residents needs with the staffing that is available. LPA interviewed residents in care, in which they stated staffing levels have improved over the last several months. Residents indicated that facility provided a caregiver agency to supplement staffing levels. 1 resident indicated at times they are waiting long periods of time for staff to respond to pendant pushes. Relevant party indicated there is insufficient staffing to meet the needs of the residents. Due to the information gathered, LPA finds allegation to be UNSUBSTANTIATED. 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.
Exit interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/03/2022 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 25-AS-20220103144150

FACILITY NAME:	ESKATON LODGE GRANITE BAY		FACILITY NUMBER:	317005628
ADMINISTRATOR:	DELGADO, KIMBERLY (KIM)		FACILITY TYPE:	740
ADDRESS:	8550 BARTON RD		TELEPHONE:	(916) 789-0326
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	118	CENSUS: 91	DATE:	05/03/2022
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Kimberly Delgado, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff failed to provide adequate food service
Facility hasn’t had a fire drill in 8 months
Untrained staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi, arrived at the facility unannounced to continue investigation into complaint. LPA met with Facility Administrator, Kim Delgado and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they used hand sanitizer shortly after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Receptionist.
LPA investigated allegation, "Staff failed to provide adequate food service". LPA toured the kitchen area, interviewed staff and residents, and reviewed menus. LPA toured the kitchen, refrigerator, freezer, and dry storage and observed 2-day perishable and 7-day non-perishable amount of food.

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) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 25-AS-20220103144150

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ESKATON LODGE GRANITE BAY	FACILITY NUMBER: 317005628
	VISIT DATE: 05/03/2022

NARRATIVE

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LPA observed fruits, vegetables, dairy products, meats, canned goods, and other pantry items. LPA reviewed menus, and observed 3 different specials available to residents everyday which include fresh fruits and vegetables. If residents do not like the specials of the day, facility has a "bistro" menu that provides other options. LPA interviewed staff in which they stated, portions are sufficient in size and residents can always order seconds if requested. Staff interviews indicated that residents are served fruits and vegetables daily. LPA interviewed residents in which they stated they have sufficient amount of food available to eat and are served fruits and vegetables. At times residents do not like the quality of food provided but they have the bistro menu to order from when they want options. Due to the information gathered, LPA finds allegation to be UNFOUNDED.
LPA investigated allegation, "Facility hasn’t had a fire drill in 8 months". LPA reviewed facility documentation and interviewed staff and residents. LPA reviewed facility documentation and observed fire drills were conducted on 2/9/21, 4/28/21, 8/31/21, 11/17/21, and 3/29/22. LPA interviewed caregivers, in which they stated fire drills are conducted throughout the year and they receive training on emergency protocols. LPA interviewed residents in which they stated they hear when the facility is conducting fire drills and they get a notice stating drills will be taking place. Due to the information gathered, LPA finds the allegation to be UNFOUNDED.
LPA investigated allegation that facility has "untrained staff". LPA interviewed staff and reviewed facility documentation. Staff interviews indicate facility provides training throughout the year online and in-person. LPA interviewed 3 staff members that were hired within the last 3 months, and all staff indicated they were provided on-line training, in person training, and shadowed other staff prior to working on their own. LPA reviewed 5 caregiver files and training documents. LPA observed facility provided required amount of yearly training. Due to the information provided, LPA finds allegation 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.
Exit interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4