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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
585000698
Report Date:
01/15/2025
Date Signed:
01/15/2025 01:56:43 PM
Document Has Been Signed on
01/15/2025 01:56 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/
DIRECTOR:
PATRICIA CORDELL
FACILITY TYPE:
740
ADDRESS:
515 HARRIS STREET
TELEPHONE:
(530) 749-1786
CITY:
MARYSVILLE
STATE:
CA
ZIP CODE:
95901
CAPACITY:
72
TOTAL ENROLLED CHILDREN:
0
CENSUS:
32
DATE:
01/15/2025
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:
Robert Coe
TIME VISIT/
INSPECTION COMPLETED:
02:06 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Executive Director Robert Coe.
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. LPA reviewed several records.
LPA was informed during this visit there is an issue with fire panel and the facility is currently on a fire watch. The issue started about 3am this morning. Executive Director stated the fire marshal was notified and is involved with getting the fire panel repaired. Executive Director said he will send in an incident report within seven days.
The following shall be updated and submitted to Community Care Licensing Division by the end of the month
-LIC 308 designation of administrative responsibility
-LIC 500 facility personnel or staff schedule
Multiple topics were discussed.
No deficiencies cited.
Troy Ordonez
TELEPHONE:
(916) 263-4700
Kerry Hiratsuka
TELEPHONE:
(916) 591-0210
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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