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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000603
Report Date: 05/01/2023
Date Signed: 05/01/2023 01:45:03 PM


Document Has Been Signed on 05/01/2023 01:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:PRESTIGE ASSISTED LIVING AT OROVILLEFACILITY NUMBER:
045000603
ADMINISTRATOR:GEORGE DINO CORREAFACILITY TYPE:
740
ADDRESS:400 EXECUTIVE PARKWAYTELEPHONE:
(530) 534-8160
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:88CENSUS: 35DATE:
05/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Dino Correa - Executive DirectorTIME COMPLETED:
02:00 PM
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05/01/2023 11:45 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Dino Correa - Executive Director, ( 6063467740 exp.9/01/2024 ) and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed a self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms.

LPA Knight and the Executive Director toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, dining room, and storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed.

Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Medication is locked in a secured medication room.

Administrator certificate is current. Fire extinguishers fully charged and were inspected in March 2023. Smoke detectors are all operational and hard wired to fire department and tested annually by Johnson Controls. All employees requiring background checks are cleared. All required postings are displayed within facility.

No pools/bodies of water are on premises. No firearms are on premises. Facility conducts emergency drills monthly and rotates between fire, evacuation and various others.

No deficiencies are being cited as a result of today’s inspection.



Exit interview conducted and copy of report was provided to Dino Correa - Executive Director.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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