045000603-9-7-2023-59-AS-KHOS-CVLK2P-20230912073129

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 09/07/2023
Date Signed: 09/07/2023 01:03:23 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
06/20/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20230620155043

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT OROVILLE		FACILITY NUMBER:	045000603
ADMINISTRATOR:	GEORGE DINO CORREA		FACILITY TYPE:	740
ADDRESS:	400 EXECUTIVE PARKWAY		TELEPHONE:	(530) 534-8160
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY:	88	CENSUS:	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Sonya Gonzalez.- Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not give residents’ medication as prescribed - UNSUBSTANTIATED
Staff do not properly keep records of medication being distributed - UNSUBSTANTIATED
Staff do not ensure the disposal of expired and/or discontinued medication - UNSUBSTANTIATED
Staff mismanage medication - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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09/07/2023 11:00 AM Licensing Program Analysts (LPAs) Rebecca Knight and Jaynae Boyles made an unannounced visit to the facility and met with Executive Director Sonya Gonzalez. The purpose of this visit was to deliver complaint investigation results.

During the course of the investigation LPA interviewed the Executive Director and 6 staff. LPA reviewed the following documents:: MAR, Physician’s report, Admission Agreement, care plan for 5 residents, physicians orders for 1 resident, staff list with telephone numbers, resident list,

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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 4

Control Number 59-AS-20230620155043

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: PRESTIGE ASSISTED LIVING AT OROVILLE	FACILITY NUMBER: 045000603
	VISIT DATE: 09/07/2023

NARRATIVE

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Page 1

Staff do not give residents’ medication as prescribed - UNSUBSTANTIATED

It was reported that medications are not being dispensed properly.

LPA review of EMAR for Resident 1 (R1) revealed that R1 had been prescribed Quetiapine (Seroquel) 100 mg on 11/23/2020, 1.5 tablets were to be taken by mouth at bedtime. Also, on 11/23/2020 R1 was prescribed Quetiapine (Seroquel) 100 mg, 1 tablet to be taken in the morning. According to the EMAR both of these prescriptions were discontinued on 6/16/2023. On 6/16/2023 a new prescription for Quetiapine (Seroquel) 50 mg was started and dispensed 2 tablets once per evening.

LPA reviewed physician’s orders for R1 for prescriptions for Quetiapine (Seroquel). 11/23/2020 Order summary: Quetiapine Fumarate Tablet 100 MG Give 1 tablet by mouth in the morning for agitation supervised self-administration AND Give 1.5 tablet by mouth at bedtime for agitation supervised self-administration. 06/16/2023 Order summary: Quetiapine Fumarate Oral Tablet 50 MG (Quetiapine Fumarate). Give 2 tablets by mouth in the evening for depression.

4 of 4 staff stated they use a computer with an EMAR to ensure they are dispensing the correct medication to the correct resident. They check the resident photo, name, and prescription before dispensing.

Administrator stated the facility uses the point click care computer system which has the resident’s photo and bubble pack medications. Staff compares the order on the screen to the bubble pack and photograph and double check that they match.

It was determined that the facility dispensed medications as prescribed by R1’s physician. Staff use the EMAR to ensure they are dispensing medications to residents properly. This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 59-AS-20230620155043

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: PRESTIGE ASSISTED LIVING AT OROVILLE	FACILITY NUMBER: 045000603
	VISIT DATE: 09/07/2023

NARRATIVE

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Page 2

Staff do not properly keep records of medication being distributed

It was reported that medications are not being recorded properly.

Staff interviews revealed that the computer system gives staff the option to click “No medication has been dispensed” or “Yes medication has been dispensed. “This information is saved in the computer system as soon as the resident takes the medication and logged in the resident’s EMAR.

Administrator stated using the point click care system, staff click that the medication has been given, and the computer system will not let staff leave their shift until they have dispensed the medications. This allegation is unsubstantiated.

Staff do not ensure the disposal of expired and/or discontinued medication - UNSUBSTANTIATED

It was reported that medications are not being destroyed timely.

During staff interviews it was learned that when a medication is discontinued staff are notified by the physician or pharmacy. Each resident has a profile in the computer system that has all of their orders and a list of discontinued medications. This is documented on each shift. When a medication is discontinued it is pulled from the med cart, recorded on the destroy record, and placed in a jug that contains a solution that destroys the medication. Two med techs are present during destruction of medications.

Administrator stated the facility either gets a fax or communication from the resident’s doctor and that is faxed to the pharmacy . The facility then discontinues the medication in the computer, it is stamped and signed off and filed in the resident’s file. Two people dispose of medications and the facility has a disposal record. The resident services director and one other employee discontinues medications. The facility has a jug with drug destroyer solution which is used to destroy the medications. There is a form that is placed in the resident file that shows the medication has been discontinued. This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20230620155043

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: PRESTIGE ASSISTED LIVING AT OROVILLE	FACILITY NUMBER: 045000603
	VISIT DATE: 09/07/2023

NARRATIVE

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Page 3
Staff mismanage medication - UNSUBSTANTIATED

This allegation is broad in scope and was investigated by LPA while conducting interviews and document reviews for the three aforementioned allegations on this same complaint, all of which concern the management of medications by the facility. This allegation in 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.

An exit interview was conducted. A copy of the report was provided to Executive Director Sonya Gonzalez.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4