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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001241
Report Date: 05/29/2025
Date Signed: 05/29/2025 01:48:42 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/12/2024 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20241112094927
FACILITY NAME:ESKATON GOLD RIVER LODGEFACILITY NUMBER:
347001241
ADMINISTRATOR:TINA RILEYFACILITY TYPE:
740
ADDRESS:11390 COLOMA RDTELEPHONE:
(916) 852-7900
CITY:GOLD RIVERSTATE: CAZIP CODE:
95670
CAPACITY:134CENSUS: 82DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Alfredo CruzTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff are not following infection control protocols.
INVESTIGATION FINDINGS:
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On 05/29/25, Licensing Program Analyst, Kimberly Viarella made an unannounced visit to this faciltiy to deliver the findings of this investigation. LPA identified herself upon arrival, stated the purpose of the visit and asked ot meet wiht the Designated Facility Administrator/Executive Director (ED), Alfredo Cruz. LPA meet with Cruz and a brief interview followed.

During the course of this investigatin, this LPA learned that there were residents who contracted Covid and that it spread from the memory care community to assisted living. On 11/13/24, it was reported by the Interim Administrator, Tina Riley, that there were currently a total of 8 residents and 4 staff positive with Covid. Riley stated that she had implemented their infection control plan and that all staff were required to wear masks in order to assist in mitigating the spread of the Covid virus. Riley also stated that they were social distancing during activities. Riley went on to say that they had contacted the Department of Public Health and provided them with line lists of those infected. The facility completed blanket testing in memory care and assisted living, as well as with staff on days 1, 3, and 5.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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 3
Control Number 27-AS-20241112094927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ESKATON GOLD RIVER LODGE
FACILITY NUMBER: 347001241
VISIT DATE: 05/29/2025
NARRATIVE
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LPA learned from interviews that staff members (S3 and S4) were reviewing video footage to ensure that all staff were wearing their masks and utilizing their PPE as directed. Both S3 and S4 stated that they saw 2 employees not wearing their masks as directed. S3 informed this LPA that those employees were coached and counseled on the importance of following infection control protocols.

In addition, when this LPA conducted her visit on 11/14/24, she also observed a staff member (S5) on the first floor not wearing a mask.

The standard for the preponderance of evidence has been met and the Department finds the allegation,
"Staff are not following infection control protocols," to be SUBSTANTIATED. This deficiency has been cited on the LIC 9099D page.

According to the California Code of Regulations, Title 22, no other deficiencies were observed or cited during today's visit. A copy of this report was provided and an exit interview was conducted with Alfredo Cruz.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20241112094927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ESKATON GOLD RIVER LODGE
FACILITY NUMBER: 347001241
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2025
Section Cited
CCR
87470(b)(2)
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Infection Control Rqmts. 87470(b)(2)
(b) In addition to ...with a contagious...(2) All staff ...Personal Protective Equipment (PPE) to prevent exposure to infectious agents...
The licensee did not ensure the above regulation was enforced as evidenced by:


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The ED stated that since the time of this complaint, addtional trainings on infection control procedures have taken place and staff who did not/do no follow those protocols have been/will be counseled and disciplined. ED will provide LPA with documentation showing the trainings and disciplianry actions that were conduted.
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Based on interviews with S2 and S3 along with this LPA's observations on 11/14/25, 3 staff members were not following the infection control protocol and were not wearing masks/PPE. This posed a potential threat to the health, safety, and/or personal rights of residents in care.
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This infomation will be submitted to CCL and a copy to the LPA at CCLASCPSacramentoRO@dss.ca.gov by close of business 6/06/25.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3