<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602540
Report Date: 11/06/2024
Date Signed: 11/06/2024 03:33:21 PM

Document Has Been Signed on 11/06/2024 03:33 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PRESTIGE ASSISTED LIVING AT LANCASTERFACILITY NUMBER:
197602540
ADMINISTRATOR/
DIRECTOR:		ANALILIA ZARZGOZAFACILITY TYPE:
740
ADDRESS:43454 30TH STREET WESTTELEPHONE:
(661) 949-2177
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 68TOTAL ENROLLED CHILDREN: 0CENSUS: 46DATE:
11/06/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Analilia Zaragoza (Administrator)TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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
Licensing Program Analyst (LPA) Evelin Rios made an unannounced case management- annual continuation visit to continue the Annual Required visit that was started on 11/05/2024. LPA met with the administrator Analilia Zaragoza and explained the reason for this visit.

The continued annual visit consisted of staff file reviews and medication review.

Staff Records: LPA conducted file review of five (5) staff records to insure forms and training are up to date and in compliance with licensing forms. LPA and administrator discussed ยง1569.618 and 87411(c)(1) in regards to first aid and CPR training.

Medication: Medications are centrally stored in designated rooms and are kept locked. On 11/05/2024, LPA observed two (2) medication carts in the the assisted living unit and one (1) medication cart in the memory care unit. LPA observed medication carts locked. On 11/06/2024 at 11:30 a.m. Centrally Stored Medication Destruction Records (CSMDR) were reviewed. Facility also utilizes digital Medication Administration Records (MARs).

No citations issued on this date. Exit interview conducted. Copy of report provided.

Eva MillerTELEPHONE: (818) 596-4373
Evelin RiosTELEPHONE: 424-299-6104
DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3