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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005590
Report Date: 12/21/2023
Date Signed: 01/09/2024 04:58:03 PM

Unsubstantiated


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
11/15/2023 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231115100453
FACILITY NAME:ESCALON SENIOR ESTATEFACILITY NUMBER:
397005590
ADMINISTRATOR:RICK REEDFACILITY TYPE:
740
ADDRESS:16460 S. ESCALON BELLOTATELEPHONE:
(209) 838-0888
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY:15CENSUS: 15DATE:
12/21/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jenilyn Tabaco and Diana ReitzTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Staff do not ensure the residents have consistent hot water while in care

Staff do not provide a comfortable temperature for the residents
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 12/21/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff, Jenilyn Tabaco and Diana Reitz, who were briefly interviewed. This LPA requested that facility staff go ahead and contact the facility designated Administrator, Rick Reed, to inform him that CCL was present at this time. The facility designated Administrator was unable to come to this facility during today's complaint visit.
Current census was 15 residents.
The purpose of this visit was to deliver the findings of this complaint investigation to the facility and its representatives at this time.
Based on a brief tour of this facility, it was observed that the hot water being dispensed from the resident restrooms were measured within the allowed range of 105-120 degrees at this time.
Based on observation while touring this facility, this LPA observed that the thermostat was set at a temperature to maintain compliance with the regulations. The facility was observed to be well heated while the temperature outside was overcast at an estimated 59 degrees.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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 2
Control Number 27-AS-20231115100453
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: ESCALON SENIOR ESTATE
FACILITY NUMBER: 397005590
VISIT DATE: 12/21/2023
NARRATIVE
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As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred.

There were no deficiencies observed or cited at this time.

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2