045000603-8-15-2024-59-AS-KHOS-D8BGYC-20240820054518

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 08/15/2024
Date Signed: 08/15/2024 01:25:32 PM

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
07/01/2024 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20240701085558

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: 40	DATE:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Sonya Gonzalez - Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not provide medical attention to resident in a timely manner - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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08/15/2024 12:30 PM 08/20/2024 03:00 PM 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 memory Care Director and staff and reviewed and incident report related to the complaint.

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: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240701085558

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: 08/15/2024

NARRATIVE

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Staff did not provide medical attention to resident in a timely manner. - UNSUBSTANTIATED

It was reported that on 06/10/2024 Resident 1 (R1) had a notable large wound with fresh and dried blood on their head. Staff had said that R1 fell and they were not going to send R1 to receive care.

LPA reviewed an incident report that states on 06/08/2024 Resident 1 (R1) was found on the ground in the courtyard. R1 had a visible injury to their head. Hospice was notified and instructed staff to call 911. Family was notified. R1 was transported to ER for evaluation and treatment. R1 returned to the facility the same day.

Expressions Director stated R1 was on hospice and staff notified hospice that R1 had a fall. The hospice nurse instructed staff to send R1 out to the hospital. When R1 was brought back the ER had done basic wound care, had cleaned and bandaged the wound and gave instructions to wash gently, keep clean and dry, use antibiotic ointment and bandage the wound two times a day. Any time staff put the bandage on R1 would rip it off immediately. R1 would rip the bandage off numerous times a day.

It was determined that after R1 fell they were transported to the ER for evaluation and treatment and returned to the facility the same day. Staff were providing first aid care and bandaging the wound but R1 would remove the bandage from the wound. 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: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

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