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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397004125
Report Date: 03/20/2024
Date Signed: 04/11/2024 10:53:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
12/18/2023 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231218124124
FACILITY NAME:PRESTIGE ASSISTED LIVING AT MANTECAFACILITY NUMBER:
397004125
ADMINISTRATOR:EDGAR PARRAFACILITY TYPE:
740
ADDRESS:1130 EMPIRE AVE.TELEPHONE:
(209) 239-4531
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:130CENSUS: 89DATE:
03/20/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Edgar ParraTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff are not provided proper size gloves to assist residents.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 03/20/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Edgar Parra at this time. A brief interview was conducted with the facility designated Administrator at this time.
Current census was 89 residents, of which, 18 residents resided in the Memory Care unit of this facility which was also referred to as Expressions.
A brief tour of the first and second floor of this facility was conducted.
The purpose of this visit was to deliver the findings of this investigation to this facility and it's representative at this time.
Based on interviews conducted and the information that was gathered during this investigation, it was learned that the overall supplies for hygiene, cleaning, and facility staff supplies were ordered on a monthly basis by the facility designated Administrator Edgar Parra. After gathering the lists from the several department heads, the facility designated Administrator would then pull together the lists and conduct a mass purchase on behalf of all department heads and their respectable staff.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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 2
Control Number 27-AS-20231218124124
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PRESTIGE ASSISTED LIVING AT MANTECA
FACILITY NUMBER: 397004125
VISIT DATE: 03/20/2024
NARRATIVE
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Based on a review of the facility invoice orders through their third party vendor, Medline Healthcare, it was learned that gloves, among other supplies, were ordered monthly with enough supplies to cover all of the needs of the staff.

As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited during today's complaint visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2