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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700638
Report Date: 04/06/2023
Date Signed: 04/06/2023 09:33:42 AM


Document Has Been Signed on 04/06/2023 09:33 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



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: 3DATE:
04/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:CHARLES EGUAVOENTIME COMPLETED:
09:45 AM
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On 4/6/2023, Licensing Program Analysts (LPA's) Cassie Yang and Sarah Benson arrived at the facility unannounced to conduct a case management visit. LPAs met with Administrator (Admin) and explained the purpose of the visit.

The facility is currently licensed for (6) non-ambulatory, hospice waiver of 2. During today's visit, there are (3) residents and 0 resident on hospice services.

During today's visit, LPA's and Admin toured the interior of the facility to ensure the health and safety of residents in care. In areas toured, no immediate health and safety violation observed. LPA's observed (3) residents in their private rooms. LPA observed the staff room to be vacant. Admin informed LPA that Admin and his wife are the only ones utilizing the staff room during NOC shifts.

LPA's and Admin discussed staffing shortage at the facility. Admin informed LPA's he has not posted position openings but waiting on staff recommendations.

As a result of today's inspection, no deficiencies cited.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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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