<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
585000698
Report Date:
01/18/2024
Date Signed:
01/18/2024 04:20:48 PM
Document Has Been Signed on
01/18/2024 04:20 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 NORTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
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:
37
DATE:
01/18/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Andreana Locklin Wiggin
TIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Hiratsuka conducted this unannounced annual visit.
This facility has a fire clearance for 72 non-ambulatory with six whom may be bedridden. The main entrance opens to a small foyer that leads to the main front area of the facility. There are administration offices to the left of the main entrance. There is a memory care unit with delayed egress and its own courtyard. This is a two story building. LPA inspected several apartments.
Multiple topics were discussed.
No deficiencies cited.
SUPERVISOR'S NAME:
Troy Ordonez
TELEPHONE:
(916) 263-4700
LICENSING EVALUATOR NAME:
Kerry Hiratsuka
TELEPHONE:
(916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE:
01/18/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/18/2024
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
1