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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 04/15/2024
Date Signed: 04/15/2024 11:52:56 AM

Substantiated


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
03/19/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20240319134311
FACILITY NAME:PRESTIGE ASSISTED LIVING AT OROVILLEFACILITY NUMBER:
045000603
ADMINISTRATOR:GONZALES, SONYAFACILITY TYPE:
740
ADDRESS:400 EXECUTIVE PARKWAYTELEPHONE:
(530) 534-8160
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:88CENSUS: 45DATE:
04/15/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:SONYA GONZALESTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Cameras are not allowed in resident’s private rooms.
INVESTIGATION FINDINGS:
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On 04/15/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 03/19/24. LPA Gurriere met with Sonya Gonzales, Administrator, and explained the purpose of the visit.

Cameras are not allowed in resident’s private rooms.

During the interview process, documents were obtained to include Physician’s Reports, Admission Agreements, a letter from California Advocates for Nursing Home Reform (CANHR), employee names and telephone numbers, resident names, and resident power of attorney names and telephone numbers.



continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
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 4
Control Number 59-AS-20240319134311
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: 04/15/2024
NARRATIVE
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During the investigation process, the administrator and family members were interviewed. The residents, Resident 1 and Resident 2 were observed; however, were not interviewed due to their cognitive impairment. In addition, LPA Gurriere toured the apartments of the memory care residents.

The current resident Admission Agreement (AA) does not have a clearly stated camera policy in place. If the facility implements an addendum in their AA for future residents that includes prohibiting cameras or video surveillance in residents private living areas, it will apply only to new admissions moving forward and would not apply to the residents prior to that change.

The licensee is required to promote and protect resident rights to privacy and dignity as specified in existing statute and regulations, Personal Rights Section 87468 and Health and Safety Code 1569.269. The Licensing Program Analyst (LPA) will determine on a case-by-case basis if a resident or resident’s use of any personally operated video surveillance cameras violates any resident or resident’s right to privacy and dignity. The best practice shall be that the resident or the resident’s power of attorney shall have signed an informed consent.

It was reported that two families are requesting to use video cameras in the resident’s apartments. The following shall apply:

· Residents are allowed to have cameras in their apartments provided that the resident or the resident’s power of attorney signs a consent.
o Under no circumstances shall a second party sign a consent on the resident’s behalf.
o The video surveillance shall not have the capability of an audio component; thus, an audio component shall not be allowed.

· The video camera cannot violate anyone else’s rights; therefore, if the resident has a roommate, that resident or the resident’s power of attorney shall have a written consent to allow the camera in the residents’ apartment. If the licensing agency receives a complaint from another resident, the LPA would need to investigate to determine if their rights were violated.

· If the licensee wishes to add an addendum to their AA, they shall submit the new AA to the licensing agency for review and approval prior to implementation.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 59-AS-20240319134311
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: 04/15/2024
NARRATIVE
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It is noted that the licensee did not have an updated AA on file with the licensing agency when addressing the cameras in resident apartments. The department does not have a specific regulation or a policy in place regarding having cameras in resident apartments but does honor resident’s personal rights to maintain cameras in their personal spaces as long as there is consent and other resident’s rights are not violated.

It was determined that the above allegation did happen and a policy around video surveillance in resident rooms was not in place at the time of admission for the residents in question; therefore, the above findings are Substantiated.

Appeal Rights were explained and provided to the facility representative listed above and an exit interview was conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20240319134311
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/22/2024
Section Cited
HSC
1569.269(a)(5)
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§1569.269(a)(5) - (a) Residents of residential care facilities for the elderly shall have all of the following rights: (5) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment.
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The Licensee shall develop a plan for meeting the health and safety code which shall address training and staffing regarding cameras in resident rooms. The plan shall be submitted to Community Care Licensing by 04/22/24.
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This requirement is not met as evidenced by: Based on interviews and records reviewed, the licensee failed to ensure that residents were allowed to have a camera in their apartment, which is a personal rights violation to residents in care. This poses a potential risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
LIC9099 (FAS) - (06/04)
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