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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001241
Report Date: 05/26/2022
Date Signed: 05/26/2022 04:00:22 PM


Document Has Been Signed on 05/26/2022 04:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LODGEFACILITY NUMBER:
347001241
ADMINISTRATOR:NEAL TORRESFACILITY TYPE:
740
ADDRESS:11390 COLOMA RDTELEPHONE:
(916) 852-7900
CITY:GOLD RIVERSTATE: CAZIP CODE:
95670
CAPACITY:134CENSUS: DATE:
05/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Neal TorresTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Kevin Gould arrived to conduct an unannounced required 1 year annual inspection on 06/02/2021. LPA met with Administrator Neal Torres and explained the purpose of the visit. Neal Torres is the Administrator and holds certificate #6032067740 that expires on 01/02/2023

This facility is a two story building licensed to serve one hundred and twenty nine (129) non-ambulatory residents. The Facility has a current dementia program waiver to serve in their special care unit. The facility has a hospice waiver for 15 residents. The facility is allowed to serve up to 5 bedridden residents. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA toured 4 courtyards.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at (119) degrees Fahrenheit in hall bathroom sink on on the assisted living A side, hot water temperature was measured at 118 degrees Fahrenheit on the memory care B side which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke detectors and carbon monoxide detectors are in compliance with fire safety. LPA toured kitchen area. LPA measured hallway temperatures, downstairs hallway was measured at 70 degrees Fahrenheit, upstairs hallway was measured at 80 degree Fahrenheit. LPA toured activity rooms, and theater room.

LPA observed centrally stored medications and toxins was kept locked and inaccessible to clients. LPA observed centrally stored medications to be locked and secured. LPA reviewed associations, First aid kit was checked and is complete. No deficiencies were found during today's inspection. Exit interview conducted and a copy of this provided to the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
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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