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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 585000698
Report Date: 11/09/2020
Date Signed: 11/09/2020 10:45:10 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2020 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 25-AS-20200312154138
FACILITY NAME:PRESTIGE ASSISTED LIVING AT MARYSVILLEFACILITY NUMBER:
585000698
ADMINISTRATOR:STRAHL, BRANDYFACILITY TYPE:
740
ADDRESS:515 HARRIS STREETTELEPHONE:
(530) 749-1786
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY:72CENSUS: 46DATE:
11/09/2020
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:BRANDY STRAHLTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Personal Rights – Staff made a false statement regarding a resident’s room.
INVESTIGATION FINDINGS:
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Donna Gurriere, Licensing Program Analyst (LPA) was in contact with Brandy Strahl, Administrator. A physical visit could not be made due to the orders in place regarding the Covid 19 Virus. The following was alleged: Staff made a false statement regarding a resident’s room.

Based on LPAs review of records and interviews with the administrator and numerous staff persons (9) the following information was disclosed:

Personal Rights – Staff made a false statement regarding a resident’s room. During the interview process, it was reported that staff told a resident that her room on the independent side of the facility had “flooded,” to justify to the resident why she had to move to the memory care unit. The resident’s room did not flood. When the resident was in the independent side of the facility, it was reported that she was showing signs of confusion in her daily living. The resident was not interviewed, as she has since passed away. Allegation is Substantiated.
Health and Safety Code 1569.269(a)(1) is being cited on the attached LIC 9099D. Appeal Rights are provided, and a closure interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 25-AS-20200312154138
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PRESTIGE ASSISTED LIVING AT MARYSVILLE
FACILITY NUMBER: 585000698
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2020
Section Cited
HSC
1569.269(a)(1)
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Health and Safety Code 1569.269(a)(1) To be accorded dignity in their personal relationships with staff, residents and other persons. A resident was not treated with dignity when she was told that her room had flooded, and she had to move from the independent side of the facility to the memory care unit. Staff made a false statement to the resident in regard to her room flooding.
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The administrator agrees to provide training to the staff persons in regards to Personal Rights for the residents.
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Based upon LPAs review of records and interviews with the administrator and staff, the licensee did not ensure that a resident was treated with dignity. This poses a potential health, safety and personal rights risk to the resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC9099 (FAS) - (06/04)
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