197602540-11-5-2024-31-AS-ERIS-DAR2LH-20241105162934

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197602540
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:29:43 PM

Document Has Been Signed on 11/05/2024 04:29 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 LANCASTER		FACILITY NUMBER:	197602540
ADMINISTRATOR/ DIRECTOR:	ANALILIA ZARZGOZA		FACILITY TYPE:	740
ADDRESS:	43454 30TH STREET WEST		TELEPHONE:	(661) 949-2177
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 68	TOTAL ENROLLED CHILDREN: 0	CENSUS: 46	DATE:	11/05/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Analilia Zaragoza (Administrator)		TIME VISIT/ INSPECTION COMPLETED:	04:35 PM

NARRATIVE

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At 9:05 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual inspection at the facility mentioned above. LPA met with Executive Director, Kortnie Spitznogle. LPA explained the reason for the visit. This facility is licensed as a Residential Care Facility for the Elderly. The facility has an approved fire clearance for a capacity of sixty-eight (68) non ambulatory residents of which seven (7) may be bedridden on the ground floor only.

LPA Rios along with Maintenance Director, Victor Ramirez conducted a physical plant tour of the facility at approximately 9:25 a.m., LPA observed the following:

The main entrance is being utilized for the visitors and employees. Screening area is located immediately upon entrance. There is a reception desk by the entrance to greet visitors. A sign in sheet, hand sanitizer, are available for guest and residents. The facility has a designated waiting area upon entrance.

Common areas: LPA toured an activity room by the dining area. Activity calendars were posted in different areas available to residents. The dining area was clean and spacious to sit the capacity of the facility. Located by the dining area is an outdoor space with a grill and outdoor furniture for residents. There are no bodies of water in the facility. A breakfast menu was posted by the dining area available to residents.

Kitchen/Food Inspection: In the kitchen LPA observed staff in the process of cleaning after serving breakfast. LPA observed a white board with information about dietary restrictions and needs of certain residents. The facility works with two companies to come up with nutritious meals and the weekly menu. According to the Head Cook food purchasing is done every Tuesday or as needed.

Bedrooms: LPA toured three (3) vacant and seven (7) occupied resident bedrooms. Bedrooms were appropriately furnished and had sufficient lighting. Bedrooms that were being repaired or updated were locked, inaccessible to residents in care. (Continue to LIC809-C)

Eva Miller	TELEPHONE: (818) 596-4373
Evelin Rios	TELEPHONE: 424-299-6104
	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 LANCASTER	FACILITY NUMBER: 197602540
	VISIT DATE: 11/05/2024

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(continued from LIC809)
Bathrooms - LPA observed resident bathrooms were clean and sanitary. The restrooms have grab bars and non skid shower mats. Hot water temperature was measured in four (4) randomly selected bathrooms on the first floor and second floor. Hot water measured at a range of 116.1°F to 118.7°F within regulation.

Two (2) delayed egress doors were tested on the first floor and were observed functioning properly. Smoke/carbon monoxide detectors were located throughout the facility. Smoke detector log is kept by the Maintenance Director. Smoke detectors in resident rooms are checked monthly by Maintenance Director. Records indicate no issues. Fire extinguishers appeared to be fully charged and service tag displayed last serviced date 09/09/2024. LPA observed two (2) evacuation chairs at the top of two (2) stairways.

Records Review - LPA reviewed five (5) residents records to insure compliance of licensing forms. LPA reviewed certificate of liability insurance, Emergency Disaster Plan LIC610, staff schedule and emergency drill training. The last fire alarm test was conducted with the Fire Drill on 11/01/2024.

LPA Rios was informed by the Administrator and Executive Director, Prestige Assisted Living At Lancaster had been sold and the sale occurred sometime in September 2024. According to the Administrator and Executive Director, staff including themselves, were made aware of the sale sometime last week. LPA was informed the Licensee is currently working on a written notice to provide to residents and their responsible party. A follow up interview with the Executive Director informed LPA the sale had not been finalized. According to staff interviews, staff and residents were not aware of the licensee's intent to sell or that an offer to purchase the facility was made.

Due to time restraints, LPA was unable to complete the annual visit at this time. LPA did not finish reviewing staff records or medication documentation at the time of this visit. A follow-up visit will be conducted at a later date to complete the annual inspection.

Deficiency observed (refer to LIC809-D). Exit Interview Conducted. Appeal Rights and a copy of this report issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/05/2024 04:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 LANCASTER	FACILITY NUMBER: 197602540
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

(a) Notwithstanding Section 1569.19, in the event of a sale of a licensed facility where the sale will result in a new license being issued, the sale and transfer of property and business shall be subject to both of the following:(1) The licensee shall provide written notice to the department and to each resident or his or her legal representative of the licensee's intent to sell the facility at least 30 days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above by not providing a written notification to CCL and residents in care of licensee's intent to sell or when a bona fide offer was made which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/15/2024
	Plan of Correction
1 2 3 4	Licensee will provide a written notice to the department in regards to the sell of the property and include contact information for the current Licensee representative.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Eva Miller	TELEPHONE: (818) 596-4373
Evelin Rios	TELEPHONE: 424-299-6104
	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC809 (FAS) - (06/04)

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