347001241-2-7-2024-27-AS-CACL-CYAT58-20231207132506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001241
Report Date: 11/16/2023
Date Signed: 02/07/2024 10:45:09 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2023 and conducted by Evaluator Kevin Gould

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230705114802

FACILITY NAME:	ESKATON GOLD RIVER LODGE		FACILITY NUMBER:	347001241
ADMINISTRATOR:	NEAL TORRES		FACILITY TYPE:	740
ADDRESS:	11390 COLOMA RD		TELEPHONE:	(916) 852-7900
CITY:	GOLD RIVER	STATE: CA	ZIP CODE:	95670
CAPACITY:	134	CENSUS: 78	DATE:	11/16/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Neal Torres		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Physical Plant: Resident's bathroom is not kept clean by facility staff.

INVESTIGATION FINDINGS:

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This report is being amended to revise the findings delivered on 11/16/23 as the department has obtained additional information regarding the allegations.

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Eskaton Gold River Lodge (RCFE) on 11/16/23 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Neal Torres and together discussed the investigation details.

The department could not corroborate the allegations regarding the cleanliness of R1's bathroom. LPA Gould made an unannounced inspection on 7/6/23 and conducted a tour of the facility to ensure health and safety of residents and observed the resident's bedroom and bathroom to be clean and well maintained. Interviews with housekeepers at the facility did not reveal any pattern or documentation of the bathroom being dirty. The department could not obtain any evidence to support the facility not being clean, sanitary and in an odorless condition. Report continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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 5

Control Number 27-AS-20230705114802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ESKATON GOLD RIVER LODGE	FACILITY NUMBER: 347001241
	VISIT DATE: 11/16/2023

NARRATIVE

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The department could not corroborate the allegations regarding the cleanliness of R1's bathroom. LPA Gould made an unannounced inspection on 7/6/23 and conducted a tour of the facility to ensure health and safety of residents and observed the resident's bedroom and bathroom to be clean and well maintained. Interviews with housekeepers at the facility did not reveal any pattern or documentation of the bathroom being dirty. The department could not obtain any evidence to support the facility not being clean, sanitary and in an odorless condition.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegation of Physical Plant is unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2023 and conducted by Evaluator Kevin Gould

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230705114802

FACILITY NAME:	ESKATON GOLD RIVER LODGE		FACILITY NUMBER:	347001241
ADMINISTRATOR:	NEAL TORRES		FACILITY TYPE:	740
ADDRESS:	11390 COLOMA RD		TELEPHONE:	(916) 852-7900
CITY:	GOLD RIVER	STATE: CA	ZIP CODE:	95670
CAPACITY:	134	CENSUS:	DATE:	11/16/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lynn Perena		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Neglect/Lack of Supervision: Resident was missing due to lack of care and supervision.
Reporting Requirements: Facility is not reporting incidents.

INVESTIGATION FINDINGS:

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This report is being amended to include required information that was omitted by LPA in order to meet department standards of required information including who LPA met with during the inspection.

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Eskaton Gold River Lodge (RCFE) on 11/16/23 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Lynn Perena and together discussed the investigation details.

Based on the interviews and records obtained during the investigation process, the department has determined the allegations are been be substantiated. Interviews with staff members and R1’s authorized representatives revealed the facility did not adjust the care plan for resident who required a higher level of care. A meeting was held at the facility with facility representatives and R1’s authorized representatives to address R1’s physical decline and increased medical needs. Although the facility agreed that a meeting to address the needs of the resident with R1’s authorized representatives and an increased level of care was discussed, no changes were made to the care plan or frequency of checks for R1.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 27-AS-20230705114802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ESKATON GOLD RIVER LODGE	FACILITY NUMBER: 347001241
	VISIT DATE: 11/16/2023

NARRATIVE

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Although there were several directives for reduced care and supervision prior to the meeting, the department has concluded the facility made no changes or alterations to the supervision agreement once it was determined the resident had increased medical needs requiring care and supervision. The department has determined the facility should have developed a plan for a higher level of care and if the resident’s needs could not be met, served the resident with an eviction notice due to needing a higher level of care.

Additionally, The department has determined based on record review the facility did follow all reporting requirements in terms of reporting suspected abuse. Facility did write and submit a report of suspected elder abuse to the department and law enforcement. However, the department has determined that the facility did not report the suspected abuse in a timely manner that meet the requirements of Title 22 regulations and the Welfare Institutions Code (WIC) that requires suspected elder abuse with serious bodily injury to be reported to law enforcement within two hours of knowledge of the suspected abuse and per documentation received law enforcement was not notified until 7/7/23. This is also corroborated by family reports to law enforcement with no other pending report prior to their report given to police on or before 7/5/23.

Per California Code of Regulations, Title 22, the following deficiencies are cited during today's inspection.

Exit interview conducted and a copy of this report and appeal rights were left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 27-AS-20230705114802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ESKATON GOLD RIVER LODGE	FACILITY NUMBER: 347001241
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/17/2023 Section Cited CCR 87464(d)	1 2 3 4 5 6 7	Basic Services: A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-Admission	1 2 3 4 5 6 7	Facility will provide a written plan of correction by the POC date to incorporate a "red flag" system by where a resident with a change in condition is red flagged and is automatically placed on frequent checks until the resident is reasessed or a new care plan is put in place and the red flag is removed.
	8 9 10 11 12 13 14	Appraisal and providing the other basic services specified below, either directly or through outside resources. This requirement was not met as evidenced by a care meeting taking place with resident, their authorized representatives and facility staff where resident’s increased medical needs and physical decline was discussed. Despite the admission of a change of condition and increased medical needs, no changes to the resident’s care plan or increased supervision were established which poses an immediate health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 11/30/2023 Section Cited CCR 87211(b)	1 2 3 4 5 6 7	Reporting Requirements: Any suspected physical abuse that results in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within two (2) hours as required by Welfare and Institutions	1 2 3 4 5 6 7	Facility has agreed to conduct additional training on reporting requirements and provide evidence of topics discussed during the training and documentation training was received by all mandated reporters at the facility.
	8 9 10 11 12 13 14	Code Section 15630(b)(1) Which poses a potential Health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5