045000603-9-24-2024-59-AS-KHOS-D9LJE4-20240930065833

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:00:55 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
08/13/2024 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20240813094903

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:	09/24/2024
		UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Sonya Gonzalez - Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure medications are dispensed as prescribed. - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

09/24/2024 01:00 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 Executive Director, Expressions Director and staff. LPA reviewed the following: Two patient discharge summaries, two video clips, one photograph, Medication Administration Records for the months of June and July 2024, physical therapy notes, physician’s report, care plan for one resident.

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: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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 4

Control Number 59-AS-20240813094903

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: 09/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA reviewed patient discharge summary from Oroville Hospital dated 07/09/2024. Resident 1 (R1) was admitted on 07/07/2024 diagnosis adrenal insufficiency due to lapse in long term steroids. 08/01/2024 Discharge summary for R1. R1 was admitted on 07/29/2024 diagnosis was altered mentation, possible polypharmacy.

LPA reviewed Medication Administration Record (MAR) for R1 which states that R1 was prescribed methylprednisolone Oral Tablet 4 MG on 04/09/2024. According to Mayo Clinic Methylprednisolone is a corticosteroid (cortisone-like medicine or steroid). It works on the immune system to help relieve swelling, redness, itching, and allergic reactions. In the month of June 2024 this drug was dispensed to R1 on the dates of 06/01/2024 through 06/30/2024. In the month of July 2024 this medication was dispensed 07/01/2024 through 07/06/2024. This medication was on hold from 07/07/2024 through 07/09/2024 and through 07/11/2024 while R1 was hospitalized. This drug was discontinued on 07/13/2024.

MAR documents that R1 started Prednisone on 10/25/2022. According to Mayo Clinic Prednisone is a corticosteroid (cortisone-like medicine or steroid). It works on the immune system to help relieve swelling, redness, itching, and allergic reactions. In the month of June 2024 this drug was dispensed to R1 on the dates of 06/01/2024 through 06/30/2024. In the month of July 2024 this drug was dispensed to R1 on the dates of 07/01/2024 through 07/06/2024, this drug was on hold dates of 07/07/2024 through 07/30/2024.

On 08/21/2024 LPA reviewed Prednisone medication against MAR. Prednisone on MAR states 1.5 pills one time a day. Current bubble pack started on 08/14/2024 there were 5 days used, resident had been out in hospital for 2 days and there were 25 days left on the bubble pack card with 39 doses. According to the MAR and current medication count the medication has been dispensed as prescribed.

LPA reviewed the entire MAR (all medications) for R1 for the months of June 2024 and July 2024. All medications were dispensed as prescribed according to the MAR.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 59-AS-20240813094903

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: 09/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA reviewed a photograph of med room cabinet that contained medications for R1. LPA also observed this cabinet and medications on 08/21/2024 during a visit to the facility. Memory Care Director stated R1 is on cycle meds and staff goes through and checks to see if they need to be ordered. R1 came to the facility with a box of overflow medications when they moved in. What is up in the cabinet are R1’s next meds for when they run out of their current supply. Stated R1’s medications are being dispensed as they should be. When a medication pops up yellow on the computer that is staff’s signal that they can dispense the medication.

LPA viewed two video clips that show R1 ambulating independently in their apartment. One clip is dated 08/02/2024, the other is undated.

LPA visited the facility on 08/15/2024 and observed R1 was seated in a wheelchair in the dining room at a table with 3 other residents and 1 staff. Staff stated that R1’s physical therapist had been at the facility that day and told staff that R1 could not take more than 3 steps.

LPA reviewed notes from physical therapist for the dates of 06/20/2024 through 07/30/2024. On 07/20/2024 physical therapy appointments were increased to twice per week. Notes state that R1 seems more confused, lethargy increased, unable to walk,

Memory Care Director stated R1 often has episodes when they will tell staff they are tired and didn’t sleep well. Stated R1 uses a walker and a wheelchair. Staff always start with the walker and if R1 is leaning or unsafe they put R1 in their wheelchair. Stated it just depends on how R1 is feeling that day. R1 has their good days when they won’t even pull their call light and will get up and walk down the hallway. If R1 is not steady on their feet, staff will not let them just take off with their walker by themself. Staff will ask R1 and if it’s best to use the wheelchair they will use it.

Continued n LIC9099-C

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240813094903

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: 09/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Although the hospital discharge papers indicate diagnosis of “adrenal insufficiency due to lapse in long term steroids” there is not a preponderance of evidence that the facility did not dispense these steroid medications as prescribed leading up to R1’s hospitalization. Another discharge paper from the hospital indicates “altered mentation, possible polypharmacy” as the diagnosis but there is not a preponderance of evidence that indicates that medications were not dispensed as prescribed to R1 leading up to this hospitalization. This allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation 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: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4