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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340313383
Report Date: 09/19/2024
Date Signed: 09/19/2024 03:22:14 PM

Unsubstantiated


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
05/24/2024 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20240524160147
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: DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Chantel Krahn, Resident Care CoordinatorTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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-Staff did not seek medical care in a timely manner for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 9/19/24, and met with the Resident Care Coordinator, Chantel Krahn, to deliver complaint investigation findings regarding the above stated allegation.

During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation.



***********************************************Continued on LIC9099-C***************************************************
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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-20240524160147
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 VILLAGE
FACILITY NUMBER: 340313383
VISIT DATE: 09/19/2024
NARRATIVE
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Allegation: Staff did not seek medical care in a timely manner for resident.
The concern was that staff (S1) did not contact hospice services for resident (R1). Interview with the Resident Care Coordinator (RCC) indicated that the day of concern was 5/17/24. RCC indicated that hospice services were contacted and hospice arrived the same day, 5/17/24, to provide care to R1. Interview with hospice services indicated that they were contacted by the facility on 5/17/24 and 5/19/24 to provide a hospice PRN visit. According to interview with hospice services and hospice documentation, R1 was seen on 5/17/24 for an occasional cough. Interview with hospice services indicated that R1 denied any pain and there was no notation of R1 having anxiety during the visit. On 5/17/24, hospice nurse provided a nebulizer treatment for R1. Interview with hospice services indicated that the facility contacted them frequently and that they had no concerns regarding the facility.

Interviews with staff (S1, S3, and S4) indicated that they have never observed staff not providing timely care to residents. Interviews with S1, S3, and S4 indicated that staff contact hospice services immediately when a hospice resident requires medical attention. Interview with resident (R2) indicated that they receive timely medical attention from facility care staff. Interview with resident (R3) indicated that they have not had any medical emergencies. Interviews with R2 and R3 indicated that they make all of their medical appointments.

Based on interviews conducted and documentation obtained, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2