045000644-10-25-2023-59-AS-KHOS-CX5JGK-20231031070228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000644
Report Date: 10/25/2023
Date Signed: 10/25/2023 02:56:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
09/19/2023 and conducted by Evaluator Jaynae Boyles

COMPLAINT CONTROL NUMBER: 59-AS-20230919164116

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT CHICO		FACILITY NUMBER:	045000644
ADMINISTRATOR:	CORREA, GEORGEDINO		FACILITY TYPE:	740
ADDRESS:	1351 E. LASSEN AVENUE		TELEPHONE:	(530) 899-0814
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	79	CENSUS: 60	DATE:	10/25/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Excecutive Director- Scott Blow		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff does not ensure residents are being isolated for communicable diseases.

INVESTIGATION FINDINGS:

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On 10/25/2023 Licensing Program Analysts (LPAs) Jaynae Boyles and Ivan Avila made an unannounced visit to the facility and met with Executive Director Scott Blow. The purpose of this visit was to deliver the results of a complaint investigation.

During the interview process, the director of health care services and the resident were interviewed. Documents were received and reviewed to include discharge paperwork from Enloe for the resident.

Coninuted on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

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 59-AS-20230919164116

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PRESTIGE ASSISTED LIVING AT CHICO	FACILITY NUMBER: 045000644
	VISIT DATE: 10/25/2023

NARRATIVE

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During the investigation, the director advised that the resident was diagnosed with shingles and that she contacted the Butte County Public Health and the regional nurse for Prestige Care. The director reported that she asked the resident if she would agree to dine in her room and the director stated that the resident agreed to do so. There were conflicting statements by the director and the resident, as the resident stated that she did not isolate herself in her room. Orders for isolation were not recommended by the treating physician, Public Health, or the regional nurse. Based on the information received, no other residents were at risk during this time.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to the executive director, Scott Blow.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

LIC9099 (FAS) - (06/04)

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