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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001241
Report Date: 04/22/2024
Date Signed: 04/22/2024 10:25:57 AM


Document Has Been Signed on 04/22/2024 10:25 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ESKATON GOLD RIVER LODGEFACILITY NUMBER:
347001241
ADMINISTRATOR:NEAL TORRESFACILITY TYPE:
740
ADDRESS:11390 COLOMA RDTELEPHONE:
(916) 852-7900
CITY:GOLD RIVERSTATE: CAZIP CODE:
95670
CAPACITY:134CENSUS: 87DATE:
04/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Neal TorresTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski met with facility administrator Neal Torres and explained the purpose of the visit.

LPA Moleski concluded an investigation regarding medication injections on 4/22/24. During the course of that investigation, LPA Moleski interviewed Torres, three residents (R1-R3), seven medication technicians (S2-S8), and one licensed nurse (S1). According to Torres, four diabetic residents were taking injectable insulin (R1-R4) at the onset of the investigation.

LPA Moleski reviewed four months' worth of medication administration records (MARs) for R1-R4’s injectable medications. LPA Moleski compared employee initials in these records to a list of employees and observed that initials for these injectable medications corresponded with the initials of licensed nurses, and with medication technicians.

LPA Moleski reviewed LIC 602s for R1-R4. All four have diabetes. R1 is not able to perform R1’s own injections due to dementia, according to the most recent LIC 602, which is dated 5/3/23. However, R1 has a doctor's note on file dated 2/14/24 granting approval for R1 to self-administer injections.

R4 "needs assistance" with injections, according to the most recent LIC 602, dated 12/6/23. LPA Moleski requested Torres to seek clarity from R4's doctor with regard to self-administration of injections.

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Torres.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2024
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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