<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197602540
Report Date:
05/04/2022
Date Signed:
05/04/2022 02:23:53 PM
Unsubstantiated
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2019
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20191115154931
FACILITY NAME:
PRESTIGE ASSISTED LIVING AT LANCASTER
FACILITY NUMBER:
197602540
ADMINISTRATOR:
MARIA MULLINS
FACILITY TYPE:
740
ADDRESS:
43454 30TH STREET WEST
TELEPHONE:
(661) 949-2177
CITY:
LANCASTER
STATE:
CA
ZIP CODE:
93536
CAPACITY:
68
CENSUS:
41
DATE:
05/04/2022
UNANNOUNCED
TIME BEGAN:
10:15 AM
MET WITH:
Brandy Strahl
TIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of care and supervision resulted in multiple falls and injuries
Facility staff failed to seek medical attention for the resident in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit to finish investigation into the allegations above. LPA met with facility staff and explained the reason for this visit.
Regarding the allegations above previous visits were conducted on 4/13/22 and 11/21/19 regarding the allegations above. On previous visits interviews were conducted with residents and staff and resident records were reviewed and copies of pertinent information was obtained.
Lack of care and supervision resulted in multiple falls and injuries and Facility staff failed to seek medical attention for the residents in a timely manner
It is alleged that in November of 2019 resident #1 (R1) had a fall inside the facility and staff did not properly pay attention to R1 and that facility did not seek medical attenion for R1 in a timely manner. The complainant was not able to give the full name of R1. LPA conducted interviews with facility staff and they checked facility records going back to November of 2019. The name given by the complainant did not show that R1 was a resident at the facility or that the facility had a resident by the name that was given. It was mentioned that R1 lived in room #108 at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/04/2022
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
31-AS-20191115154931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
PRESTIGE ASSISTED LIVING AT LANCASTER
FACILITY NUMBER:
197602540
VISIT DATE:
05/04/2022
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
26
27
28
29
30
31
32
LPA interviewed staff and found that the resident who resides in room #108 has lived in the room since before 2019. LPA checked and there were no serious incident reports or emergency calls regarding that resident. There was also a mention of another resident #2 (R2) having falls and not being assisted. There was not a full name of R2 given by the complainant. LPA conducted interviews with staff who were working at that time and there was no recollection of any incidents or names mentioned by the complainant. Based on the information obtained through interviews and record review both of these allegations are deemed Unsubstantiated at this time. Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/04/2022
LIC9099
(FAS) - (06/04)
Page:
2
of
2