502700575-8-4-2022-27-AS-KHOS-CHDQC6-20220817120238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700575
Report Date: 08/04/2022
Date Signed: 08/04/2022 12:07:09 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
06/01/2022 and conducted by Evaluator Albert Johnson

COMPLAINT CONTROL NUMBER: 27-AS-20220601161656

FACILITY NAME:	A PRESTIGE LIVING		FACILITY NUMBER:	502700575
ADMINISTRATOR:	PIERRE-JEROME,SIMONE		FACILITY TYPE:	740
ADDRESS:	3208 TEHAMA CT		TELEPHONE:	(209) 284-0075
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	6	CENSUS: 5	DATE:	08/04/2022
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Simone		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is denying resident telephone calls
Facility is not assisting resident to medical appointments

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Johnson delivered the investigative findings for the allegations listed above. LPA spoke with Simone and Sophia.

Based on interviews with the residents and the administrator, the facility is not denying telephone calls or failing to assisting with medical appointments(last appointment was on 2/1/22). The facility was attempting to protect R1 from an agency or individual that was attempting to become the Power of Attorney(POA) for R1 and was requiring R1 to sign papers that would identify them as the POA. The agency in question " the Argent Firm" has not been vetted, is not related to R1 and discovered R1 by a search of unclaimed property.

Continued

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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-20220601161656

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: A PRESTIGE LIVING	FACILITY NUMBER: 502700575
	VISIT DATE: 08/04/2022

NARRATIVE

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Based on the above information the facility did report this to the Ombudsmans office and that agency is working with an attorney to get R1 conserved and to establish necessary accounts to provide R1 with a place to secure his money and property.

The Department has investigated the above mentioned allegations and has determined that the complaint is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC9099 (FAS) - (06/04)

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