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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:50:03 PM

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
04/05/2024 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20240405150650
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: 38DATE:
06/18/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sonya Gonzalez - Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Care is not being provided timely due to low staffing. – SUBSTANTIATED
Residents are not receiving showers as listed in their care plan. – SUBSTANTIATED
INVESTIGATION FINDINGS:
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06/18/2024 11:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Executive Director Sonya Gonzalez. 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, residents and staff. LPA reviewed the following documents: Staff roster with telephone numbers, resident roster, Staff schedule for the weeks of 03/29/24 through 04/05/24, Activities schedules for assisted living and memory care, Admission agreement, care plan, physician’s report, ADL logs for 3 residents.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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 6
Control Number 59-AS-20240405150650
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: 06/18/2024
NARRATIVE
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Page 1

Care is not being provided timely due to low staffing - SUBSTANTIATED

It was reported that the facility has low staffing especially at night and weekends. Only 1 caregiver on several occasions in the assisted living side and care is significantly affected.

LPA reviewed the staffing schedule for the dates of 3/29/2024 through 04/02/2024 and found that during the NOC shift on 04/01/2024 and 04/02/2024 there was one med tech on the assisted living side and 1 PCA on the memory care side of the facility.

Staff stated that residents do not wait a long time for toileting assistance.

Resident interviews revealed that sometimes caregivers are other places and they understand but sometimes it takes too long.

It was determined on 04/01/2024 and 04/02/2024 during the NOC shift there was one med tech on the assisted living side and 1 PCA on the memory care side of the facility. This is inadequate staffing to ensure proper care and supervision of all residents. This allegation is substantiated.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 59-AS-20240405150650
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: 06/18/2024
NARRATIVE
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Page 2

Residents are not receiving showers as listed in their care plan. – SUBSTANTIATED

It was reported that a resident who is supposed to have 4 showers per week had to wait 6 days for a shower.

LPA reviewed Resident 3’s (R3) care plan dated 04/21/2023 which states that staff will provide physical assistance with showers per the shower schedule. R3’s Physician’s Report states R1 is unable to bathe themself. According to R3’s Service Plan they require physical assistance with four showers per week. LPA reviewed R3’s Activities of Daily Living (ADL) charting for the month of March 2024. Only five days indicated that R3 had received a shower, 14 days indicated that no service was needed on those days, and on 12 days no charting was completed. On the 12 days where no charting was completed it is unknown as to whether R1 received a shower as scheduled.

Staff stated that R3 gets showers on Sunday, Monday, Wednesday, and Friday. There has been one or two times that R3 wanted to wait to take their shower but then it’s too late to complete the shower because it takes 2 hours to give R3 a shower. Staff always try to get to R3 in the morning the next day. When R3 was recently discharged from the hospital they didn’t get a shower for 2 days because R3 was very weak.

At the time of the interview R3 stated three or four weeks ago they had gone 6 days without showering due to low staffing. R3 stated they had not refused showers.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 59-AS-20240405150650
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: 06/18/2024
NARRATIVE
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Page 3
ED stated there have been times just recently where staff try to give R3 a shower and they have refused three days in a row. Staff reported they were trying to work with R3 but R3 is refusing. LPA questioned ED regarding the ADL charting and the fact that 12 days showed no charting for showers for R1. LPA questioned how the facility charts when a resident has refused their shower. Ed stated if a shower was refused the ADL chart would be dated and in the comments it would indicate an "R" with the initial of staff and a time stamp. ED stated for this month (March 2024) and this resident, the documentation is poor and unfortunately does not show for R1’s showers.

It was determined that staff are offering R3 showers and occasionally R3 does refuse showers. However, staff are not properly documenting when R1 refuses showers. According to the ADL charting there are 12 days where no charting for bathing R1 was completed. The facility needs to improve their Activities of Daily Living (ADL) charting practices using the Point-Click-Care system. This allegation is substantiated.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the allegation that staff financially abused a resident is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview was conducted and the report was provided to executive director Sonya Gonzalez.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 59-AS-20240405150650
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: 06/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/02/2024
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:
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Licensee agrees to submit a plan to ensure that staffing is adequate at all times but particularly on weekends and holidays. Licensee shall submit the plan to LPA as proof of correction.
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Based on document review and interviews the licensee did not ensure that staffing was appropriate to meet the needs of residents in care on the dates of 04/01/2024 through 04/02/2024 when there was one med tech on the assisted living side and 1 PCA on the memory care side of the facility during the NOC shift. This poses a potential Health, Safety and Personal Rights risk to residents in care.
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The proof of correction is to be received by LPA Knight by 07/02/2024.
Type B
07/02/2024
Section Cited
HSC
1569.2(c)
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Health and Safety Code section 1569.2(c) provides: (c) "Care and supervision" means the facility assumes responsibility for, or provides… ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement was not met as evidenced by:
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Licensee agrees to conduct a staff training concerning the requirement to properly document assistance with Activities of Daily Living (ADL). Licensee shall submit the staff sign in sheet with dates and staff signatures as proof of correction. Additionally, licensee agrees to submit a plan for staff to follow specific to providing R1 assistance with showering and ensuring that R1 receives the required number of showers outlined in their care plan.
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Based on interviews and document review it was determined that staff did not ensure that Resident 1 is provided assistance in showering with the required number of showers as required in their care plan. This poses a potential health and safety risk to residents in care.
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The proof of correction is to be received by LPA Knight by 07/02/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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
04/05/2024 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20240405150650

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: DATE:
06/18/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
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Facility is not providing activities as listed on activity schedule. - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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Facility is not providing activities as listed on activity schedule. - UNSUBSTANTIATED
It was reported that there are not enough activities and activity times have been changed without consulting residents.
LPA reviewed the activity schedules for assisted living and memory care for April 2024. There was a good mix of activities planned to include group exercises, board games, card games, bowling, bingo, manicures and movie matinees on both schedules.
Staff stated very few residents normally want to participate in activities. When they do participate the residents enjoy bingo, poker, chair exercises, manicures, karaoke, and puzzles. There are always staff present and accompany the residents outside.
Resident interviews revealed that the activities director quit and some residents were assisting with activities. One resident had provided a list of preferred activities and times to the administrator.
Administrator stated they explained to residents that they cannot just change the activity schedule without prior approval. The facility is currently recruiting for a new activities director.
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.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 6