397004125-4-1-2022-27-AS-SDOB-CD8LWW-20220406090749

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397004125
Report Date: 03/30/2022
Date Signed: 04/01/2022 05:39:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2021 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20211011121311

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT MANTECA		FACILITY NUMBER:	397004125
ADMINISTRATOR:	EDGAR PARRA		FACILITY TYPE:	740
ADDRESS:	1130 EMPIRE AVE.		TELEPHONE:	(209) 239-4531
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	130	CENSUS: 79	DATE:	03/30/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Edgar Parra		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not prevent resident from engaging in inappropriate behaviors

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 03/30/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Edgar Parra, who was briefly interviewed.
Current census was 79 residents.
The purpose of this visit was to conclude this complaint investigation and to present the findings to the facility designated Administrator.
Based on interviews conducted during the course of this investigation, it was learned that R1 resided on the second floor of this facility. During R1's time as a resident in this facility, there were reported issues of incontinence involving R1 and other residents. It was learned that these incontinence issues were a constant battle with the resident and the accompanying licensed medical professional. It was learned that several inquiries and trials were implemented trying to sort out the cause of the problem in hopes of raising R1's quality of life.
It was learned that facility staff were involved with this ongoing issue surrounding R1 and interviews revealed that they were diligent in trying to address the consequences once they took place. It was learned that

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20211011121311

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: PRESTIGE ASSISTED LIVING AT MANTECA	FACILITY NUMBER: 397004125
	VISIT DATE: 03/30/2022

NARRATIVE

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facility staff assisted R1 to the best of their abilities given the strain on overall staffing and available manpower.
Based on interviews conducted, it was learned that the facility administrative team was made aware of the situation surrounding R1. It was learned that the administrative team did take strides in trying to assist R1 as much as possible without infringing on R1's personal rights and those of the other residents around R1.
Based on interviews conducted, it was learned that even though there were accidents and issues of incontinence surrounding R1, this facility, its staff, and the administrative team were informed about the situation and responded accordingly in treating the issue and attempting to maintain overall cleanliness in this facility.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of UNSUBSTANTIATED meant that although the allegations 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 at this time.

Exit Interview

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC9099 (FAS) - (06/04)

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