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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000603
Report Date: 07/02/2024
Date Signed: 07/02/2024 10:36:22 AM


Document Has Been Signed on 07/02/2024 10:36 AM - 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: 39DATE:
07/02/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:JALUISA TIPPENSTIME COMPLETED:
10:30 AM
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On 07/02/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to conduct a case management visit in an effort to follow up on a plan of correction in that the carpets are being cleaned. LPA Gurriere met with Jaluisa Tippens, Health Care Director, and explained the purpose of the visit.

During the walk through, overall the carpets appeared to be clean. In rooms 5, 9 and 11 they are in need of a deep clean or spot cleaning. It was reported that the carpets are cleaned quarterly by a local professional company. The last time they cleaned the carpets was on 04/01/24. The housekeeper reported that she cleans the carpets on a weekly basis using a shampoo carpet cleaner.

The facility appears to have developed a plan to maintain and clean the carpets. There will be no citation or civil penalties today.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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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