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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340313383
Report Date: 12/16/2024
Date Signed: 12/16/2024 04:17:00 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
12/12/2024 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20241212093901
FACILITY NAME:ESKATON VILLAGEFACILITY NUMBER:
340313383
ADMINISTRATOR:HAMMAM, TIGHEFACILITY TYPE:
741
ADDRESS:3939 WALNUT AVETELEPHONE:
(916) 974-2000
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:500CENSUS: 408DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Chantel Krahn, Resident Care CoordinatorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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-Facility staff are not changing bandage as ordered by home health
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 12/16/24, and met with the Resident Care Coordinator (RCC), Chantel Krahn, to open a complaint investigation and deliver findings regarding the above stated allegation.

During today's visit, LPA reviewed documentation pertinent to the investigation and conducted interviews.

Interviews with RCC and Home Health Nurse indicated that Resident (R1) is to receive wound care two times per week for a skin biopsy on the right foot. Home Health Nurse indicated that they typically only provide wound care for residents 2-3 times per week and anything more would need a signed physician's order. Home Health Nurse indicated that when the initial assessment was conducted with R1 it was agreed that they would be providing wound care two times per week. Home Health Nurse did not indicate
********************************************Continued on LIC9099-C***************************************************
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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-20241212093901
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: 12/16/2024
NARRATIVE
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any concerns regarding the facility and stated that the facility's Wellness Nurse will provide wound care for R1 when requested by R1. R1's Progress Notes from 10/27/24-12/14/24 indicated that the facility nurses have provided wound care several times for R1 on the days that home health wound care is not scheduled. Home Health's Plan of Care indicated that they will be providing wound care one time per week starting 10/22/24 and two times per week beginning 11/3/24. Home Health Plan of Care also indicated that wound care will end effective 12/20/24.

Based on interviews conducted and documentation reviewed, 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.

Exit interview was conducted with RCC and a copy of this report was provided to the facility. The signature of the RCC on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
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