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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313383
Report Date: 09/07/2022
Date Signed: 09/07/2022 02:59:09 PM

Document Has Been Signed on 09/07/2022 02:59 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ESKATON VILLAGEFACILITY NUMBER:
340313383
ADMINISTRATOR:KLICK, GREGFACILITY TYPE:
741
ADDRESS:3939 WALNUT AVETELEPHONE:
(916) 974-2000
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 500CENSUS: 399DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Greg KlickTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 9/7/22 to conduct a Case Management visit. LPA was Joined by Stacy Barlow and Ellie Holloway. LPA the Executive Director and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required Department COVID-19 protocols. LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

LPA toured the interior and exterior of the facility in independent living, assisted living and memory care. In the areas toured no immediate health, safety, or personal rights violations were observed.


No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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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