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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700655
Report Date: 01/15/2025
Date Signed: 01/15/2025 03:07:35 PM

Document Has Been Signed on 01/15/2025 03:07 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 IIFACILITY NUMBER:
502700655
ADMINISTRATOR/
DIRECTOR:		MCNEAL, TANISHAFACILITY TYPE:
735
ADDRESS:1800 VALPARAISOTELEPHONE:
(209) 534-3245
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY: 6CENSUS: 4DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Massi McNeal, House ManagerTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Renee Campbell arrived at the facility to conduct an unannounced annual inspection on 01/15/2025.  LPA Campbell met with Massi McNeal, House Manager and explained the purpose of the visit.

LPA Campbell inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. This facility is a single story building licensed to serve six (6) ambulatory residents. There are four bedrooms for the current 4 clients residing in the facility. They are not licensed to serve non-ambulatory residents. The fire exit was clear of obstacles. LPA Campbell observed the facility to be free of odor, clean and in good repair. LPA Campbell observed two (2) of the bedrooms and found them to be properly furnished with appropriate bedding and lighting. There are no bodies of water present.

LPA Campbell observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 116 degrees Fahrenheit (F) in the bathroom. Fire extinguishers, smoke alarm and carbon monoxide detectors are in good repair. The fire extinguisher was last inspected on May 2, 2024 and is full and the smoke alarm was tested and found to be functioning. Facility thermostat observed to be set at 73 degrees F. LPA Campbell checked medication storage and found medication to be locked away and inaccessible to clients. First aid kit was complete and contained scissors, tweezers and thermometer as well as a manual.

LPA Campbell requested client and staff files for review. Using all staff files found in the facility, LPA Campbell was able to verify that all staff were finger print cleared and associated to the facility. LPA Campbell reviewed 4 resident files and 4 staff files. Resident and staff files were found to be complete.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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 II
FACILITY NUMBER: 502700655
VISIT DATE: 01/15/2025
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Toxins were made inaccessible to clients in care. Toxins are stored in the storage closet off the laundry room. The House Manager provided a facility sketch to add to be added to the Department file.
The following documents will be email to LPA Campbell (Renee.Campbell@dss.ca.gov) by 01/20/2025 by 5:00 PM by end of day:
(1) LIC 308 Designation of Administrative Responsibility
(2) LIC 500 Personnel Report
(3) Copy of Administrator Certificate   
(4) LIC 610 Emergency Disaster Plan

Per California Code of Regulations, Title 22, no deficiencies were observed during today’s visit. A hardcopy of this report was provided to the facility
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
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