585000698-9-28-2021-25-AS-KHOS-C7QPQX-20211012113152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 585000698
Report Date: 09/22/2021
Date Signed: 09/28/2021 03:12:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2021 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210722132145

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT MARYSVILLE		FACILITY NUMBER:	585000698
ADMINISTRATOR:	SMITH, AUDRE		FACILITY TYPE:	740
ADDRESS:	515 HARRIS STREET		TELEPHONE:	(530) 749-1786
CITY:	MARYSVILLE	STATE: CA	ZIP CODE:	95901
CAPACITY:	72	CENSUS:	DATE:	09/22/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Audre Smith, Admin		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff were rough with resident
Resident was left on toilet for a very long time
Staff coerced family into admitting resident to facility.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegations and deliver findings. LPA met with Administrator (Admin) Audre Smith . Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask gown and gloves. Additionally, LPA was screened by Admin Andre Smith

continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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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Control Number 25-AS-20210722132145

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 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PRESTIGE ASSISTED LIVING AT MARYSVILLE	FACILITY NUMBER: 585000698
	VISIT DATE: 09/22/2021

NARRATIVE

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Staff were rough with resident

During interviews with Executive Director, staff, residents and records reviewed, it was determined that the Facility staff handled residents in a rough manner to be unsubstantiated. After interviews with residents, it was concluded that no one indicated they were being mistreated from any staff member. Staff interviews all concluded that they have never witnessed or heard about any mistreatment from staff or residents. The preponderance of evidence standard has not been met. The allegation is unsubstantiated.

Resident was left on toilet for a very long time

During interviews with Executive Director, staff, residents and records reviewed, it was determined that the Resident was left on toilet for a very long time to be unsubstantiated. After interviews with residents, it was concluded that no one indicated they have never had any issues with toileting. R1 refused to speak to LPA and did not explain or know according to complainant how long she was left on the toilet. Staff interviews all concluded that they have never witnessed or heard about anyone left on the toilet for long period of time. The preponderance of evidence standard has not been met. The allegation is unsubstantiated.

Staff coerced family into admitting resident to facility.

During interviews with Executive Director, staff, residents and records reviewed, it was determined that the Staff coerced family into admitting resident to facility to be unsubstantiated. After interviews with residents, it was concluded that no one indicated they have never had any issues with the facility trying to get them to do things they don’t want to do.. Staff interviews all concluded that they have never witnessed or heard about anyone being coerced into anything they don’t want to do. The preponderance of evidence standard has not been met. The allegation is unsubstantiated.

Based on the information obtained, records reviewed, and interviews conducted, the above allegations are Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are Unsubstantiated.

An exit interview was conducted with the ED. There are no citations given at this time.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC9099 (FAS) - (06/04)

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