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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397004125
Report Date: 07/16/2025
Date Signed: 07/18/2025 05:29:25 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
02/10/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250210172535
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:0CENSUS: 81DATE:
07/16/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Edgar ParraTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Resident not provided refund from being overcharged.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 07/16/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated representative, Health Services Director Michelle Coelho, at this time. A brief interview was conducted with the facility designated representative at this time.
Current census was 81 residents, of which, 18 residents resided in the Memory Care unit of this facility which was also referred to as Expressions.
The facility designated Administrator, Edgar Parra, arrived shortyly thereafter to this facility while this LPA was conducting this complaint visit.
The purpose of this visit was to deliver the findings of this complaint investigation to this facility and it's representative at this time.
Based on a review of the forms and documents conducted during the course of this investigation, it was observed that a former complaint was filed and investigated back on 07/30/2024 for the issue of inappropriate utility charges that were made to the facility resident accounts.
It was learned that the facility residents were inappropriately billed for a utility surcharge at that time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
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 6
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
02/10/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250210172535

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:0CENSUS: 81DATE:
07/16/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Edgar ParraTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff response times after pressing the call button was over 20 minutes.

Facility did not provide transportation as indicated in the admissions agreement.

Facility did not seek timely medical care when changes occurred.

Failed to observe for change in condition.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 07/16/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated representative, Health Services Director Michelle Coelho, at this time. A brief interview was conducted with the facility designated representative at this time.
Current census was 81 residents, of which, 18 residents resided in the Memory Care unit of this facility which was also referred to as Expressions.
The facility designated Administrator, Edgar Parra, arrived shortly thereafter to this facility while this LPA was conducting this complaint visit.
The purpose of this visit was to deliver the findings of this complaint investigation to this facility and it's representative at this time.
Based on a review of the forms and documents gathered during the course of this investigation, it was observed that the Resident Health Evaluation Assessment was signed by the responsible party for R1 and dated on 02/28/2024. It was observed that on this document it was agreed upon by the responsible party to provide transportation and assist with shopping for R1 while R1 was a resident at this facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20250210172535
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: 07/16/2025
NARRATIVE
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Based on a review of the forms and documents retrieved during the course of this investigation, it was learned that this facility maintained an alarm and alert system linked to phones that were carried by the facility staff at all times while on shift. It was learned that whenever a facility resident activated their pendant or pulled the emergency pull chords within their housing units, facility staff were expected to respond and check up on the residents within a 5-7 minute time frame. It was learned that any response time exceeding 10 minutes was viewed upon as inappropriate and were reviewed by the facility management team to determine the nature of the call, response time of the facility staff, and the reason for the extended length of time that exceeded 10 minutes.
Based on a review of the forms and documents pertaining to the call system that was being employed at this time, this LPA was able to review the call requests and types, response times, and overall length of time it took for the facility personnel to complete the check up and reset the alarm.
It was learned that the facility staff were within the allotted time frame of 5-7 minutes when responding to alerts sent to their devices. It was observed that there were several calls that exceeded the 10 minute threshold but explanations were implanted onto the system noting the reason for the excess time, location where it took place, and why. It was observed that these incidents of exceeding 10 minutes were mainly due to the facility staff handling residents with activities of daily living which exceeded the 10 minutes before they were able to reset the alarm system. It was observed that on other incidents, assistance with medications, toileting, and other resident care procedures required the staff to stay beyond the 10 minute threshold before they were able to get back to the alarm unit to reset it at that time.
Based on a review of the forms and documents retrieved during the course of this investigation, it was learned that R1 obtained the services of Home Health upon admission to this facility. It was learned that from the time frame of 03/08/2024 to 05/27/2024, there were a total of 26 visits made to this facility solely to assist and provide additional care needs to R1. These types of visits conducted through the home health agency ranged from changing dressings, wound care, and physical therapy.
It was learned that out of the 26 visits made by home health agency to assess and assist with R1, there were only (4) visits noted on the home health notes completed by the attending home health personnel which noted a change in R1's condition. It was learned that (3) of those visits conducted on 03/26/2024, 04/12/2024, and 04/19/2024 noted a change in condition but were noted as improvements for R1 at those times.
The other visit conducted on 04/26/2024 noted a change in R1's condition which required hospitalization and this facility did complete and submit an Special Incident Report (SIR), or LIC 624, to this Department and the responsible party was notified as well, at that time, for the change in condition.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20250210172535
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: 07/16/2025
NARRATIVE
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As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred.

There were no deficiencies observed or cited at this time.

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

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20250210172535
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: 07/16/2025
NARRATIVE
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The complaint investigation was completed and the allegation was deemed to be substantiated at that time with a Plan of Correction (POC) due date of 09/13/2024 to reimburse all of the facility residents who were impacted by this practice.
It was learned that at the time of this complaint being filed this facility had not fulfilled the terms of the Plan of Correction (POC) and had failed to properly reimburse all facility residents affected by this inappropriate utility surcharge fee.

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: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20250210172535
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: 07/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2025
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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It was learned that this facility did refund all inappropriate utility surcharge fees in the amount of $375 back to the facility residents on 02/27/2025.
There will be no Plan of Correction to be completed at this time.
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specified in this subdivision. 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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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: 07/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6