045000603-12-6-2023-59-AS-KHOS-CYAT2B-20231207132028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 12/06/2023
Date Signed: 12/06/2023 11:00:30 AM

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
10/02/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20231002111005

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: 35	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sonya Gonzales Executive Director		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Residents sustained falls due to lack of supervision - UNSUBSTANTIATED
Staff are not meeting resident’s hygiene needs - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

12/06/2023 10:30 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Executive Director Sonya Gonzales. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the Executive Director, Memory Care Director, and 5 staff. LPA reviewed the following documents: staff list with telephone numbers, resident list, staffing schedules for the months of September through October 2023, list of staff who called in sick for the same time period including dates and shifts ADL tracking logs.

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: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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 3

Control Number 59-AS-20231002111005

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: 12/06/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Residents sustained falls due to lack of supervision - UNSUBSTANTIATED

It was reported that residents are falling because there is only one staff providing care and supervision in the memory care unit.

LPA reviewed records of falls that were reported for the months of September through November 2023. One memory care resident fell on 09/18/23, was transported to hospital for assessment. There were no falls reported for the month of October 2023 and thus far none for the month of November 2023 in the memory care unit.

LPA reviewed memory care staffing schedules for the months of September and October 2023. The facility has four shifts in the memory care unit. All shifts had one Med Tech and one to two PCA’s. In addition, the facility has recently increased their staffing in the memory care unit.

During the month of September 2023 PCA’s called out or did not show up for their shifts on the following days during the 6:00 am – 2:00 pm shift exclusively: five days no show. 9two days PCA – Personal. One day PCA – Sick. On 9/17 two PCAs did not show up for their shifts which resulted in one PCA working back-to-back shifts to cover.

3 of 5 staff stated 2 residents have fallen, one fall resulted in a contusion. 1 of 5 staff stated that one resident fell from time to time but was not injured. 1 of 5 staff stated they did not know if there had been any falls.

Expressions Director stated I have enough staff when they don’t call in with me back here also.

Executive Director stated there are two care staff, the med tech and the director on duty to provide care.

It was determined that the facility has not had an increase in falls due to insufficient staffing and lack of supervision. This allegation is unsubstantiated.

Continued LIC9099-C

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 59-AS-20231002111005

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: 12/06/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff are not meeting resident’s hygiene needs. - UNSUBSTANTIATED

It was reported that care is not being provided because there is only one staff providing care and supervision in the memory care unit.

When staff were asked if care was being provided timely for the residents 1 of 5 staff stated they tried but when there is only one staff on the floor it’s hard. 1 of 5 staff stated No because there are not 2 PCAs in the memory care unit 24/7. 1 of 5 staff stated It is hard to get to all of the residents because they are dealing with other residents but thought that most are getting care in a timely manner. 1 of 5 staff stated now that there are 2 PCAs in the memory care unit care is going a lot smoother.

Expressions Director stated brushing teeth, brushing hair and applying deodorant should be a daily task. Staff assist them. They are logged in our PCC (Point-Click-Care) as a task under hygiene and grooming.

Executive Director stated We try to encourage the residents every day, it depends on their mood, every resident is different. Sometimes some of them don’t want to have it done in but we encourage the best we can. All ADLS are encouraged and done in the manner the residents accept.

It was determined that staffing is sufficient to ensure that resident hygiene needs are being met. This allegation is 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 Gonzales.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3