045000603-1-24-2024-59-AS-RKNT-CZSW5K-20240124155917

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045000603
Report Date: 01/24/2024
Date Signed: 01/24/2024 03:59:46 PM

Document Has Been Signed on 01/24/2024 03:59 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 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: 41	DATE:	01/24/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Sonya Gonzales - Executive Director		TIME COMPLETED:	03:30 PM

NARRATIVE

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01/24/2023 03:00 PM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with Executive Director Sonya Gonzales. Today’s visit is regarding an incident that occurred on 01/20/2024 and was reported to licensing on 01/20/2024.

It was reported that on 01/20/2024 at 4:00 PM Staff 1 (S1) was in the Activity Room putting on the football game for the residents. Resident 1 (R1) walked by S1 and smacked and grabbed their rear end. S1 immediately told R1 to stop, but R1 just walked away toward their room. At 4:07pm the incident was reported to the Executive Director (ED). ED called and spoke with S1 and was advised of the physical contact R1 did to S1. S1 was visibly upset and having a hard time with being touched inappropriately. ED advised S1 that Ed was going report the incident to local law enforcement. ED called 911 reported the incident. At approximately 5:50pm Oroville police arrived and spoke to both parties. R1 admitted to touching S1 and R1 was arrested for a misdemeanor.

During the course of the investigation it was learned that Resident 1 (R1) recently moved to another facility. S1 has been advised to contact the company’s Employee Assistance Program if they feel they would like more support.

No deficiencies were cited as a result of today’s visit. Exit interview conducted and a copy of the report was provided to Sonya Gonzales.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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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