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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005628
Report Date: 09/18/2025
Date Signed: 09/18/2025 05:04:41 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
09/11/2025 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20250911141050
FACILITY NAME:ESKATON LODGE GRANITE BAYFACILITY NUMBER:
317005628
ADMINISTRATOR:KAY DEVAULTFACILITY TYPE:
740
ADDRESS:8550 BARTON RDTELEPHONE:
(916) 789-0326
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:118CENSUS: 79DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Dina Jones, Activities DirectorTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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-Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with Dina Jones, Activities Director, to open a complaint and deliver complaint investigation findings. LPA also spoke with the Executive Director (ED), Kay Devault, by phone.

During today's visit, LPA conducted interviews and obtained documentation pertinent to the investigation. LPA obtained a copy of the Unusual Incident/Injury Report LIC624 that was sent to the former LPA on September 3, 2025 indicating that the facility found bed bugs in resident (R1's) room on the same date. The LIC624 indicated that R1's family was notified as well as their primary care physician. Facility removed all of R1's clothing from their room and laundered at a high temperature. R1 was moved to a respite room until room is cleared of bed bugs. The ED provided LPA with email communications with R1's family and power of attorney indicating that they are aware of the situation. The facility provided LPA with the minutes from the resident counsel meeting, dated September 11, 2025, indicating that there was a discussion
***********************************************Continued on LIC9099-C***************************************************
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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 2
Control Number 59-AS-20250911141050
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ESKATON LODGE GRANITE BAY
FACILITY NUMBER: 317005628
VISIT DATE: 09/18/2025
NARRATIVE
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regarding pest concerns and the ongoing pest control services. The facility provided LPA a copy of a letter that was sent to all residents and families on September 11, 2025 indicating that the facility has an anticipated community inspection for pests on September 25, 2025 and September 26, 2025. ED provided LPA with several invoices and service requests indicating services conducted in the facility to ensure the pest issue is resolved.

Based on records reviewed and interviews conducted, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. No deficiencies are being cited.

Exit interview conducted. A copy of report was provided.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2