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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000603
Report Date: 11/08/2023
Date Signed: 11/08/2023 12:41:59 PM


Document Has Been Signed on 11/08/2023 12:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 OROVILLEFACILITY NUMBER:
045000603
ADMINISTRATOR:GONZALES, SONYAFACILITY TYPE:
740
ADDRESS:400 EXECUTIVE PARKWAYTELEPHONE:
(530) 534-8160
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:88CENSUS: 33DATE:
11/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Sonya GonzTIME COMPLETED:
12:45 PM
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11/08/2023 11:35 AM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with administrator Sonya Gonzales. Today’s visit is regarding a lock on the memory carer garden gate.

During a visit to the facility on 11/01/2023 LPA observed a keyed padlock on the garden gate of the memory care unit. Currently the facility does not have a waiver for the lock on the gate. The facility has installed a chime on the gate that sounds when the gate has been opened.

LPA advised administrator that the facility may apply for a waiver in accordance with California Code of Regulations, Title 22 Section 87209 Program Flexibility and Section 87705(l)(1) through (8), This waiver approval is contingent upon receipt of updated fire clearance and approval by the fire marshal among other requirements as outlined in the aforementioned regulation. The lock must remain off of the gate until the waiver is approved by the department. If the waiver is denied the licensee shall keep the lock off of the gate and develop an alternative plan to keep the gate unlocked and secure to ensure the safety of memory care residents. If an alternative plan is required the licensee shall submit the plan to LPA Knight for approval.

Administrator stated that the facility understands all of these requirements.

No deficiencies were cited on today’s visit.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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