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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700638
Report Date: 08/24/2021
Date Signed: 08/24/2021 11:24:02 AM

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:ESTHER CARE HOMEFACILITY NUMBER:
342700638
ADMINISTRATOR:EGUAVOEN, CHARLESFACILITY TYPE:
740
ADDRESS:4415 ROLLINGROCK WAYTELEPHONE:
(916) 560-3800
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 0DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Charles EguavoenTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Melana Llopis met Licensee, Charles Eguavoen at the facility to conduct an annual inspection on 08/24/2021.
Prior to 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; upon visit completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask.

LPA was informed by licensee that there have been no residents in this facility since June 2021, as the residents who were in the this facility at that time transferred to another facility in Roseville, CA area.
LPA and licensee toured the physical plant together. LPA observed the facility to have gas and electricity. Administrator informed LPA they received their annual fee for their licensee in the mail two (2) days ago and will pay before the due date on 10/02/2021. Facility has a non-perishable food supply on hand and licensee ensured LPA perishable food would be obtained prior to admitting residents again. Facility has locked storage area for medications, knives, toxins, and confidential records.
LPA observed bedrooms for resident use have required furnishings. Showers for resident use have required grab bars and non-slip surfaces. Water temperature in the bathroom measured at 105 degrees F, which is within range.
LPA observed smoke and carbon monoxide detectors throughout the facility and observed a fire extinguisher that is fully charged and last serviced 10/29/2020.
LPA observed one (1) of five (5) resident bedrooms to need the carpet replaced due to incontinent stains and foul odor. Licensee provided proof to LPA of new carpet installment and stated they will not be accepting any new residents prior to the new installment. LPA will follow up regarding the new carpet installment prior to Licensee accepting any new residents.

Licensee stated that he will notify CCL upon admitting any new residents into the facility.
LPA and licensee reviewed infection control procedures.
Exit interview held and copy of report provided to Licensee.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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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