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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700165
Report Date: 08/01/2024
Date Signed: 08/01/2024 12:15:51 PM

Document Has Been Signed on 08/01/2024 12:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PRESTIGE CARE CENTER LLCFACILITY NUMBER:
502700165
ADMINISTRATOR/
DIRECTOR:		MCNEAL, TANISHAFACILITY TYPE:
735
ADDRESS:474 SUNDAY DRTELEPHONE:
(209) 443-7707
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY: 6CENSUS: 4DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Tanisha Mcneal, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 08/01/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced to conduct an annual inspection. LPA Campbell was met by staff on shift, Vanessa Oliva, Direct Service Provider (DSP). Ten minutes later, Administrator Tanisha McNeal arrived. Both staff were verified as being cleared to work at the facility. Upon entry, LPA Campbell observed 2 residents playing UNO at the table. The rest of the residents were at day program.

The Facility is located in a one story building with 3 bedrooms and 2 bathrooms. It is licensed to house up to 6 ambulatory residents who are developmentally disabled. Upon entry there is a common area which leads into a kitchen and a dining room. A hallway leads to Bathrooom 1, Bedroom 1, Bedroom 2 and Bedroom 3 which is connected to Bathroom 2. Bedroom 3 is shared by two residents. Across from Bathroom 1, there is a laundry room which leads into a garage that is used as an office.

LPA Campbell observed enough fresh perishables to last more than three days. The pantry non-perishables would last more than 7 days. Sharps and chemicals were locked and inaccessible to residents. When measured, hot water in bathrooms were found to 115 degrees Fahrenheit as required by regulations. The thermostat was set at 75 degrees Fahrenheit and the fire extinguisher was last inspected on 02/15/24.

Of the 4 residents living in the facility, 4 resident files were reviewed and found to be complete. Of the 13 staff employed by the facility, 3 files were reviewed and found to be missing the Employee Rights form. A Medication Administration Record was also reviewed for one client and was observed to be complete.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 CARE CENTER LLC
FACILITY NUMBER: 502700165
VISIT DATE: 08/01/2024
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Based on observation, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was conducted and a copy of this report was given to the facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
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