397004125-4-11-2024-27-AS-KHOS-D4DN8C-20240416101406

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397004125
Report Date: 03/20/2024
Date Signed: 04/11/2024 10:56:59 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
12/19/2023 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231219135257

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: 89	DATE:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Edgar Parra		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not ensure facility is clean.
Staff do not ensure facility is free from pests.
Staff do not ensure furniture used by residents is in good repair.
Staff do not properly dispose of trash.
Staff do not safeguard residents’ personal belongings.
Staff do not provide resident with eating assistance.

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 from this investigation to this facility and it's representative at this time.
Based on observations while touring this facility, this facility was maintained in compliance to be free of any insects, pests, or odors at this time. This was observed on the first and second floor as well. The facility furniture and furnishings were observed to be in good repair and able to meet the needs of the residents at this time. A review of resident bedroom furniture and furnishings was conducted and observed to be in good repair and able to meet the needs of the residents at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 709-6507
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)

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Control Number 27-AS-20231219135257

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 forms and documents gathered during the span of this investigation, it was learned that this facility employed the services of a pest control company, EcoLab, who was scheduled at least to come out on a monthly basis to spray and remove any unwanted insects, pests, or nuisance at any given time. The invoices stated that there weren't any causes for concern since there was an absence of rats, ants, and mice in this facility. The invoices further stated that there no findings noted during the time of service.
Based on interviews conducted during the span of this investigation it was learned that facility residents are treated with respect and dignity at all times. It was learned that each resident was admitted with an appraisal for needs and services that this facility has determined it was able to provide for at all times. It was learned that every resident is different and this was also true of their abilities to self care and advocate for themselves.
It was learned that most residents enjoyed gathering and eating in the dining hall during the scheduled meal times. It was learned that a few did, however, prefer to eat in their own rooms thus tray service was provided for these individuals. It was learned that facility staff would encourage and attempt to feed a resident if warranted but would never be able to force any resident to eat or intake anything against their will.

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 were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred.

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

Exit Interview

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 709-6507
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)

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