045000603-9-7-2023-59-AS-KHOS-CVLK94-20230912074143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 09/07/2023
Date Signed: 09/07/2023 01:15:50 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
07/13/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20230713153450

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT OROVILLE		FACILITY NUMBER:	045000603
ADMINISTRATOR:	GONZALES, SONYA		FACILITY TYPE:	740
ADDRESS:	400 EXECUTIVE PARKWAY		TELEPHONE:	(530) 534-8160
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY:	88	CENSUS: 34	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Sonya Gonzalez - Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility accepted new resident without required paperwork for admission. – UNFOUNDED
Resident was accepted into the facility without a medical assessment. – UNFOUNDED
Facility is not serving a variety of meals to residents in care.- UNFOUNDED

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 requested and reviewed the following documents: Physician’s report, Admission Agreement, care plan for 1 resident, facility menus for the months of June and July and August 2023.

Continued on LIC9099-C

Unfounded

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)

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Control Number 59-AS-20230713153450

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

Facility accepted new resident without required paperwork for admission – UNFOUNDED

It was reported that Resident 1 (R1) moved onto the facility on 6/23/2023 without the required paperwork for admission.

LPA reviewed the admission agreement for Resident 1 (R1) that was signed by R1’s responsible party (RP) on 06/23/2023. LPA reviewed R1’s Care Plan that includes an initiation and move in date of 6/23/2023.

Based on LPA document review this allegation is unfounded.

Resident was accepted into the facility without a medical assessment. – UNFOUNDED

It was reported that Resident 1 (R1) moved into the facility without a medical assessment.

LPA reviewed R1’s LIC602 Physicians Report with a date of examination of 06/23/2023 and was signed by R1’s physician on the same date. This report included negative TB test results.

Based on LPA document review this allegation is unfounded.

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)

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Control Number 59-AS-20230713153450

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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Facility is not serving a variety of meals to residents in care.- UNFOUNDED

LPA reviewed facility menus for the dates of May 28, 2023 through August 19, 2023. The facility menu includes breakfast, lunch, and dinner. All meals offered are varied each day, with the exception of breakfast which consists of typical breakfast fare ( cereal, eggs, bacon, toast etc.). Lunch and dinner include desert in addition to the main meal. In addition to these menus the facility also offers an “Anytime Menu” that residents can order from. This menu includes items such as a chef salad, hamburger, and various sandwich types.

Administrator stated that the assisted living and memory care sections of the facility are served the same menu. The facility uses Crandall Corporate Dietitians as their menu source.

It was determined that the facility has a varied menu and offers an “Anytime Menu” that residents in assisted living and memory care can order from if they do not like what is being served on the regular menu for the day. This allegation in unfounded.

This agency has investigated the above allegations. We have found the complaint was UNFOUNDED, meaning that the allegations are false, could not have happened, and/or are without a reasonable basis.

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)

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