347001241-6-24-2024-27-AS-SRIN-D7FVKW-20240723163103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001241
Report Date: 06/24/2024
Date Signed: 06/24/2024 05:45:27 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
06/20/2024 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20240620111402

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: 85	DATE:	06/24/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Neal Torres		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are transferring resident(s) in an unsafe manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 6/24/24, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open a complaint investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the designated facility administrator (DFA). LPA met with Neal Torres. A brief interview followed and the LPA requested the following documents: LIC 500 with contact information, Resident Roster, care and med tech staff schedules for the day in order to conduct interviews.

LPA observed the following during her visit: 9 residents participating in card games in the activity room.
40 residents seated and ready for dinner in the dining room. Medications being distributed in Memory Care.

Through interviews, this LPA learned that Assisted Living had 4 - 5 care staff (and sometimes a floater) for the AM shift with 2 med techs along with a nurse and the Resident Care Coordinator or his Assistant. The PM shift typically had 4 care staff, 2 med techs and the nurse left at approximately 7:00 PM. The NOC shift was covered by 2 staff, sometimes 1 care staff with 1 med tech and other times by 2 med techs.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

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-20240620111402

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: 06/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

This LPA was told Memory Care was staffed with the following: the AM shift had 3 care staff and 1 med tech plus the Memory Care Coordinator (MCC). The PM shift was staffed with 2 care staff plus 1 floater and a med tech. The NOC shift was staffed by 1 care staff and a med tech.

As part of this investigation, this LPA interviewed 9 staff members. 2 of the 9 confirmed that staff were not consistently transferring residents properly. This LPA learned that care staff were using the Hoyer lift by themselves (1 person instead of a 2 person assist). Operation of a Hoyer lift requires 2 people.

The standard for the preponderance of evidence has been met and the department finds the allegation, "Staff are transferring resident(s) in an unsafe manner." to be substantiated. This deficiency was cited on the LIC 9099D page.

No other deficiencies were observed or cited during today's visit. A copy of this report was provided along with Appeal Rights.

Exit interview.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 27-AS-20240620111402

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: 06/24/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/23/2024 Section Cited CCR 87411(d)(3)	1 2 3 4 5 6 7	(d) All personnel shall be given on the job training... provide knowledge of and skill in the following...as evidenced by safe and effective job performance: (3) ... to provide necessary resident care and supervision... The facility did not meet the above requirement as evidenced by:	1 2 3 4 5 6 7	Designated Facility Administrator stated they will do additional training on Hoyer operation for Memory Care staff. The nursing staff will develop and conduct the training by 07/23/23. An outline of the training along with signature sheets will be submitted to CCL at kimberly.viarella@dss.ca.gov.
	8 9 10 11 12 13 14	2 out of 9 staff interviewed stated that employees were using the Hoyer lift by themselves and not requesting a second person to assist.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3