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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 01/28/2025
Date Signed: 01/28/2025 11:21:04 AM

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
10/22/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20241022153432
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: 41DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:APRIL KALETIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee is not ensuring that proper Resident Council protocols are being followed.
Staff do not ensure that residents are provided with activities while in care.
INVESTIGATION FINDINGS:
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On 01/27/25 Donna Gurriere Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 10/22/24. LPA Gurriere met with April Kale, Office Manager and explained the purpose of the visit.

Licensee is not ensuring that proper Resident Council protocols are being followed.

During the interview process, the assistant administrator, expressions director, activities director and three staff persons were interviewed. Documents received included rental agreements, physician’s reports, resident council meeting notes and staff names and cell numbers.



continued
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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 7
Control Number 59-AS-20241022153432
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: 01/28/2025
NARRATIVE
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During the investigation, it was reported that currently the council meets one time per month and that notes are taken and distributed to the resident representative. Additionally, it was reported that when the previous administrator was involved, she did not take notes for approximately three months and did not respond to the resident council group of their concerns, which was required.

Based on investigation observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D.

Appeal Rights were explained and provided to the facility representative listed above and an exit interview was conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.

Staff do not ensure that residents are provided with activities while in care.
During the interview process, the assistant administrator, expressions director, activities director and three staff persons were interviewed. Documents received included rental agreements, physician’s reports, resident council meeting notes and staff names and cell numbers.

During the investigative process, it was reported by all staff that activities are provided to the residents. There is a full-time activities director that provides activities for the residents on the assisted living side and the expressions director and staff are responsible for ensuring that residents in the dementia side have activities through out the day. The full-time activities director is overall responsible to ensure that activities are provided on both sides of the facility. All staff stated that activities are provided.

However, during the investigation, it was reported that for numerous months, the facility van is not being used for activities outside of the facility, as the staff do not have the proper license to drive the van. The regulations state that the facility shall provide activities outside of the facility to include outings as follows: Attendance at the place of worship of the resident's choice, service activities for the community, events such as concerts, tours and plays, participation in community organized group activities, such as senior citizen groups, sports leagues, and service clubs. The admission agreement states that the facility “will provide provision for trips to social functions…”
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 59-AS-20241022153432
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: 01/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2025
Section Cited
HSC
1569.157(c)
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If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to those concerns or recommendations within 14 calendar days.
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The assistant administrator sent a copy of the resident council minutes for three months, September, October and November 2024. The facility agrees to submit a plan of correction to the licensing agency advising how this type of violation will be avoided in the future.
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This requirement was not met as evidenced by: Based on interviews and records reviewed, the previous administrator did not ensure that she responded to the concerns of the residents within 14 calendar days as required. This poses a potential risk to the residents.
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Type B
02/04/2025
Section Cited
CCR
87219(c)
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Planned Activities - The licensee shall arrange for utilization of available community resources through contact with organizations and volunteers to promote resident participation in community-centered activities.
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The administrator agrees to outline a plan as to when a staff person will obtain the license to operate the van for resident outings. The facility may be cited with civil penalties if the plan is not feasible and in a timely manner.
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This requirement was not met as evidenced by: Based on interviews and records reviewed, the administrator did not ensure that the staff had the appropriate license to operate the van. This poses a potential risk to the residents.
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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: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 59-AS-20241022153432
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: 01/28/2025
NARRATIVE
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Based on investigation observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D.

Appeal Rights were explained and provided to the facility representative listed above and an exit interview was conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.




SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
10/22/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20241022153432

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: 41DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:APRIL KALETIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff do not ensure that residents receive their mail in a timely manner.
Staff do not ensure that facility is kept clean.
Licensee does not ensure that staff are adequately trained.
Staff do not ensure that residents' care needs are being met.
INVESTIGATION FINDINGS:
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On 01/27/25 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 10/22/24. LPA Gurriere met with April Kale, Office Manager and explained the purpose of the visit.

Staff do not ensure that residents receive their mail in a timely manner.

During the interview process, the assistant administrator, expressions director, activities director and three staff persons were interviewed. Documents received included rental agreements, physician’s reports, resident council meeting notes and staff names and cell numbers.


continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 59-AS-20241022153432
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: 01/28/2025
NARRATIVE
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During the investigation, it was reported that residents on the assisted living side of the facility obtain their mail from the mailboxes provided. The staff stated that if the residents receive packages, the staff distribute them. It was stated that on the dementia side of the building, the staff deliver the mail to the residents and to their family representatives.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Staff do not ensure that facility is kept clean.

During the interview process, the assistant administrator, expressions director, activities director and three staff persons were interviewed. Documents received included rental agreements, physician’s reports, resident council meeting notes and staff names and cell numbers.

During the investigation, it was reported by all staff that the facility is kept clean. It was stated that the housekeeper and maintenance worker have a carpet shampooer that they use to spot clean and to shampoo the common areas of the facility. In addition, staff stated that when there is a spill or spot, they advise the housekeeper and maintenance worker of the concern. It was reported that management goes from room to room to point out to the housekeeper when there are issues with the carpets. Facility is also having the carpets professionally cleaned.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Licensee does not ensure that staff are adequately trained.

During the interview process, the assistant administrator, expressions director, activities director and three staff persons were interviewed. Documents received included rental agreements, physician’s reports, resident council meeting notes and staff names and cell numbers.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 59-AS-20241022153432
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: 01/28/2025
NARRATIVE
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During the investigation process, several staff persons were interviewed, and it was reported that staff receive training by video for at least two weeks with a training sign off and a training checklist. In addition, staff are provided with training on the floor with another caregiver for 3-5 days and longer if needed. Staff reported that they felt that they received adequate training.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Staff do not ensure that residents' care needs are being met.

During the interview process, the assistant administrator, expressions director, activities director and three staff persons were interviewed. Documents received included rental agreements, physician’s reports, resident council meeting notes and staff names and cell numbers.

During the investigation process, several staff persons were interviewed, and it was reported that Assisted Daily Living (ADL) skills are being met on a daily basis. ADLs included bathing, dressing, grooming, feeding, toileting, and assistance with walking. Observations of the residents is that they appear to be clean and dressed for the day.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7