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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340313383
Report Date: 02/14/2023
Date Signed: 02/14/2023 01:11:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/08/2022 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20221208104020
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: 402DATE:
02/14/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Greg KlickTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Facility does not have an operational fire alarm system
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 2/14/23 to conduct a Annual Inspection utilizing the infection control domain. LPA met with the Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed the departments current required COVID-19 protocols. 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.

During the investigation, LPAs Kevin Mknelly and Michael Hood conducted interviews and requested Sacramento Metro Fire inspection documentation pertinent to the investigation.

Sacramento Metro Fire inspection reports and statements from inspector EB indicated that they noticed, on 12/7/22 in a routine inspection, that fire alarm system in memory care had an error code and alarm that was repaired by the system company. Staff reports to the inspector indicated that the malfunction had
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
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 3
Control Number 25-AS-20221208104020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: ESKATON VILLAGE
FACILITY NUMBER: 340313383
VISIT DATE: 02/14/2023
NARRATIVE
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been occurring and been silenced by staff prior to repairs being initiated. Inspectors noted that while the alarm system would operate, the system malfunction may not have operated as designed to alert outside responders. Inspectors found that the fire alarm system in the independent living building was off line due to system upgrades. Inspectors found that they had not been notified, plans and permits had not been approved by Metro Fire and that this constituted an immediate risk to resident safety. A fire watch was instituted and the upgrade is ongoing with the oversight of Metro fire. Repairs are due to be concluded 12/15/23.

Follow- up inspections on 12/20/22 found MC system to be operating properly and on 1/4/23, IL repairs were still ongoing.

Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview was conducted with the Administrator. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20221208104020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ESKATON VILLAGE
FACILITY NUMBER: 340313383
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/21/2023
Section Cited
CCR
87203
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Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by:
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Licensee is now under the direction of Metro fire to repair issues identified.
Licnesee will submit a plan of correction identifying the measures of maintaining a fully functioning approved fire alert system and requirements for reporting malfunctions timely.The POC is due 12/21/23
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Based on interviews conducted, the facility did not ensure that they had a completely operable fire alarm system, which poses an immediate health, safety, and personal rights risk to residents in care
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Fire safety violations have a civil penalty assessed.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3