045000603-8-15-2024-59-AS-KHOS-D8BGTG-20240820053731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 08/15/2024
Date Signed: 08/15/2024 01:23:47 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
05/17/2024 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20240517075710

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:	DATE:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:			TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff violated a resident's personal rights. - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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08/15/2024 01:00 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with met with Executive Director Sonya Gonzales. The purpose of this visit was to deliver the results of a complaint investigation.

During the cours of the investigation LPA conducted interviews and reviewed relevant documents.

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-20240517075710

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 violated a resident's personal rights - UNSUBSTANTIATED

It was reported that upon returning from a medical appointment Resident 1 (R1) was surrounded by several staff members and the memory care director was instructed to conduct a body inspection on R1 to make sure a medical procedure had not been performed that could have prohibited R1 from returning to the facility.

Expressions Director (ED) stated they were asked to see if the procedure had been done but was not asked to check R1’s body at all. ED stated it was obvious that the procedure had not been done since the resident had not been gone very long at the medical appointment. ED stated they would obtain permission from the family before they performed a body check. Ed stated they wouldn’t say R1 was surrounded by staff, when the ED went into the memory care unit, R1 was sitting on the couch and two PCA’s were present.

Staff could not recall being asked to be present in the lobby when R1 returned from their appointment.

It was determined that R1 was not inspected for a surgical wound by staff when they returned to the facility from an appointment. Although there are conflicting accounts of the number of staff that were present when R1 returned this does not violate a resident’s personal rights. 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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