045000603-12-29-2020-25-AS-RLBN-BXAVVK-20210115154625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 12/29/2020
Date Signed: 12/29/2020 02:59:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/17/2020 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20200917151722

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT OROVILLE		FACILITY NUMBER:	045000603
ADMINISTRATOR:	DAVID, RACHEL		FACILITY TYPE:	740
ADDRESS:	400 EXECUTIVE PARKWAY		TELEPHONE:	(530) 534-8160
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY:	88	CENSUS:	DATE:	12/29/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	BRANDY STRAHL		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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A staff person was assisting a resident and the resident was injured.
Staff are not meeting the needs of a resident.
The facility smells like marijuana.
A staff person filed a false incident report.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst (LPA) was in contact with Brandy Strahl, Administrator. A physical visit could not be made due to the orders in place regarding the Covid 19 Virus.

A staff person was assisting a resident and the resident was injured.
The administrator, management staff, several staff persons, the resident (Resident 1) and the resident’s husband were interviewed. In addition, documents regarding the resident were received and reviewed.

**continued**

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020

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-20200917151722

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 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PRESTIGE ASSISTED LIVING AT OROVILLE	FACILITY NUMBER: 045000603
	VISIT DATE: 12/29/2020

NARRATIVE

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**continued**

During the interview process, it was reported that the resident came from a hospital stay. Once the resident was at the facility, she was transferred from the hospital wheelchair to the facility wheelchair. The resident suffered skin tears on her legs; however, it could not be determined if the skin tears were from the hospital stay and done prior to being returned to the facility or were done by the facility staff when the staff person moved the resident from the hospital wheelchair to the facility wheelchair. It was noted that the resident, per her Physician’s Report is a two person transfer. The administrator is reminded to ensure that staff are instructed and are available to support this resident with a two person transfer. Allegation is Unsubstantiated.

Staff are not meeting the needs of a resident.
The administrator, management staff, several staff persons and the resident (Resident 2) were interviewed. It was reported that a resident did not receive her showers on a regular basis. The resident reported that she does have showers on a regular basis and at times she chooses not to change her clothes. Staff persons advised that at times, the resident refuses to allow staff persons to shower her and that the staff try to encourage the resident to take her showers. Overall, it was reported that staff persons are meeting the needs of the residents, including the resident that at times does not want to shower or change her clothes. Allegation is Unsubstantiated.

The facility smells of marijuana.
During the interview process, several staff persons were interviewed. Overall, most staff persons reported that the facility did not smell like marijuana. Allegation is Unsubstantiated.

**continued**

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 25-AS-20200917151722

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 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PRESTIGE ASSISTED LIVING AT OROVILLE	FACILITY NUMBER: 045000603
	VISIT DATE: 12/29/2020

NARRATIVE

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**continued**

A staff person filed a false incident report.
The administrator and several staff persons were interviewed; however, the staff person that allegedly filed a false incident report is no longer working at the facility and could not be interviewed. The administrator was contacted, and she advised that she could not find a false incident report with the date that was specified. Other incident reports were received and reviewed; however, they did not have the information that was reported to be false. Allegation is Unsubstantiated.

Based on the information obtained and interviews conducted, the above allegations are Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are Unsubstantiated.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3