045000644-7-22-2021-25-AS-MSEY-C56S35-20210722133033

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000644
Report Date: 07/22/2021
Date Signed: 07/22/2021 12:29:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/08/2021 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210408152939

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT CHICO		FACILITY NUMBER:	045000644
ADMINISTRATOR:	BAKER, BECKY		FACILITY TYPE:	740
ADDRESS:	1351 E. LASSEN AVENUE		TELEPHONE:	(530) 899-0814
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	79	CENSUS: 56	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Executive Director (ED) Brandy Stahl		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff handled residents in a rough manner
Facility staff made residents shower with cold water
Facility staff are not reporting incidents as required

INVESTIGATION FINDINGS:

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On 06/25/2021, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegations and met with Executive Director (ED) Brandy Stahl. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by front desk receptionist.

continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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 25-AS-20210408152939

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PRESTIGE ASSISTED LIVING AT CHICO	FACILITY NUMBER: 045000644
	VISIT DATE: 07/22/2021

NARRATIVE

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Facility staff handled residents in a rough manner
During interviews with Executive Director, Memory Care Director, staff, and records reviewed, it was determined that the Facility staff handled residents in a rough manner to be unsubstantiated. After interviews with residents, it was concluded that no one indicated they were being mistreated from any staff member. Staff interviews all concluded that they have never witnessed or heard about any mistreatment from staff or residents. The preponderance of evidence standard has not been met. The allegation is unsubstantiated.

Facility staff made residents shower with cold water

During interviews with Executive Director, Memory Care Director, staff, facility tour and records reviewed, it was determined that the Facility staff made residents shower with cold water to be unsubstantiated. After interviews with residents and staff, it was concluded that no one had any complaints regarding showers and having cold water. LPA toured facility and all residents had individual bathroom/showers in their own bedroom. There were no common showers close to any offices as described in the complaint. The preponderance of evidence standard has not been met. The allegation is unsubstantiated.

Facility staff are not reporting incidents as required

During interviews with Executive Director, Memory Care Director, staff, and records reviewed, it was determined that the Facility staff are not reporting incidents as required to be unsubstantiated. After interviews with staff records review it was concluded that the facility were meeting reporting requirements, LPA observed binder with incident/death reports located in the Executive Director’s office. The preponderance of evidence standard has not been met. The allegation is unsubstantiated.

Based on the information obtained, records reviewed, and interviews conducted, the above allegations are Unsubstantiated. Although the allegation may have happened or is 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 with the ED. There are no citations given at this time.

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

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