585000698-5-5-2023-59-AS-LMUZ-CRK4J6-20230505190812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 585000698
Report Date: 05/05/2023
Date Signed: 05/05/2023 10:46:46 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
03/21/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230321152737

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT MARYSVILLE		FACILITY NUMBER:	585000698
ADMINISTRATOR:	BRANDY STRAHL		FACILITY TYPE:	740
ADDRESS:	515 HARRIS STREET		TELEPHONE:	(530) 749-1786
CITY:	MARYSVILLE	STATE: CA	ZIP CODE:	95901
CAPACITY:	72	CENSUS: 39	DATE:	05/05/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sherri Banford		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not notify residents family of residents death.

INVESTIGATION FINDINGS:

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On Friday May 5, 2023, Licensing Program Analyst (LPA) Melissa Parks arrived at the facility unannounced to deliver complaint findings into the allegation listed above and met with Health Services Director Sherri.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

Allegation: Staff did not notify residents family of residents death.
Based on interviews conducted and file reviewed, facility notified POA of R1s passing, which meets Title 22 reporting requirements. Therefore, the allegation is unfounded meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Sherri and a copy of this report was provided to the facility.

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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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