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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313383
Report Date: 02/14/2023
Date Signed: 02/14/2023 01:12:45 PM

Document Has Been Signed on 02/14/2023 01:12 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ESKATON VILLAGEFACILITY NUMBER:
340313383
ADMINISTRATOR:KLICK, GREGFACILITY TYPE:
741
ADDRESS:3939 WALNUT AVETELEPHONE:
(916) 974-2000
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 500CENSUS: 402DATE:
02/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Greg KlickTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 2/14/23 to conduct a Annual Inspection utilizing the infection control domain. LPA met with the Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed the departments current required COVID-19 protocols. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA were screened by facility staff upon entering the facility.

LPA toured the interior and exterior of the independent (IL) living, assisted living (AL) and memory care (MC) buildings and grounds of the facility to ensure health and safety of residents in care. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Infection control Leader completed the infection control domain and facility was found to be in substantial compliance at this time.

LPA is aware of fire safety requirements recently in process of repair and upgrade. These issues are addressed in a separate report.

LPA requested licensee update their staff roster in Guardian to accurately reflect current employees, submit an LIC 500 and proof of liability insurance.
During today's visit, LPA was provided a new mobile phone contact number.

No deficiencies are being cited as a result of this inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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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