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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397004125
Report Date: 09/06/2024
Date Signed: 09/10/2024 04:10:54 PM

Substantiated


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
07/30/2024 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240730152526
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: 80DATE:
09/06/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Edgar ParraTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff are billing beyond terms of admission agreement
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 09/06/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Edgar Parra. A brief interview was conducted with the facility designated Administrator at this time.
Current census was 80 residents.
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 a review of the documents, it was learned that a letter was sent from this Licensee to all residents of this facility. This letter notified all residents that this facility was going to start charging a temporary energy surcharge in the amount of $125.00 per month for a period of (3) months. This surcharge was planned to be included as a separate line item on the resident’s monthly bill.
This surcharge was not allowable as it violated the admission agreement entered into by both parties, per
licensing regulations. In lieu of the lump sum payments, all increases in rates should be to the monthly rate amortized over a 12-month period with advanced notification.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
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 3
Control Number 27-AS-20240730152526
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: 09/06/2024
NARRATIVE
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Funds collected for this rate change was unlawful and should be returned to all residents.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

Appeal rights were printed and a copy was left with the facility designated Administrator at this time.

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

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240730152526
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
HSC
1569.655(b)
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§1569.655 (b) Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase; application of section. (b) No licensee shall charge nonrecurring lump sum assessments. The notification requirements contained in subdivision (a) shall apply to increases
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Facility representative stated that a refund for all utility surcharges that have been collected from the residents will be given and will rescind the notification that was issued to the residents. If the licensee intends to require residents to pay a utility surcharge, the fees must be amortized over a 12-month period
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specified in thissubdivision. For purposes of this subdivision, "nonrecurring lump-sum assessments" mean rate increases due to unavoidable and unexpected costs that financially obligate the licensee. In lieu of the lump-sum payment, all increases in rates shall be to the monthly rate amortized over a 12-month period. This requirement was not met as evidenced by:
Based on a review of the documents and evidence, it was determined that this facility was charging all residents a lump-sum utility surcharge for three months. This poses a potential health and safety risk to the residents in care.
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and must be included in the admission agreement.
A statement of correction, along with a list of all residents who paid the utility surcharge, the amount of the surcharge that the resident paid, and the date a refund was issued to each resident, will be completed and submitted into CCL by the due date. In addition, the
licensee will update the admission agreement and submit the new admission agreement into CCL.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3