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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313383
Report Date: 12/29/2021
Date Signed: 12/29/2021 04:45:56 PM

Document Has Been Signed on 12/29/2021 04:45 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: 53DATE:
12/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH: Eric Olson, Assistant Executive Director and
Laura Zamora, MCU Director 		TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Eric Olson, Assistant Executive Director and Laura Zamora, MCU Director. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA was screened per Covid-19 precautionary measures upon entering each area of the community, using AccuShield. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. The facility is licensed for (500) residents, which includes a Memory Care Unit (MCU) for 20 residents, an Assisted Living Unit (ALU) for 40 residents, and skilled nursing unit and Independent LIving Census is currently (19) in MCU and (34) in ALU. ILU was not toured during today's annual inspection.

LPA, Assistant. Executive Director and MCU Director toured the interior of MCU and ALU, including resident rooms, dining rooms, staff bathrooms, medication rooms, and common areas. LPA observed multiple residents in MCU to be sitting in the common area, watching television and residents in ALU to be in their rooms. LPA observed all areas toured to be clean, in good repair and odor free and the bathrooms to have hand-washing posters, paper towels, soap and trash cans with lids. LPA observed various Covid-19 posters posted throughout both areas of the facility and at the entrances to each unit.

LPA, Assistant Executive Director and MCU Director completed the infection control domain, and the facility was found to be in compliance at this time. Inside temperature was observed to be 73* F. LPA, Assistant Executive Director and MCU Director discussed vaccination status of residents and staff in each unit, as well as visitation protocols per PIN 21-40, issued 8/27/2021. LPA observed signage posted at the front entrances that masks are required upon entry. Staff testing requirements were also discussed.

LPA requested a copy of LIC500 and current liability insurance be emailed to CCLD by 1/6/2022. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Assistant Executive Director.






SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2021
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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