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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002995
Report Date: 03/06/2025
Date Signed: 03/06/2025 02:15:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2025 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250228150820
FACILITY NAME:PRESTIGE ENVIRONS FOR THE AGESFACILITY NUMBER:
315002995
ADMINISTRATOR:HEARD, TERESITAFACILITY TYPE:
740
ADDRESS:5350 NORTHCLIFF DRIVETELEPHONE:
(916) 625-1012
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 1DATE:
03/06/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Teresita Heard, Administrator TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility did not abide by the admission agreement.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a 10-day inspection and met with Teresita Heard, Administrator, stating the reason for today's inspection. LPA observed staff, Treylon Heard, present also and (1) resident in their room at the start of the inspection.

During today's inspection, LPA discussed the allegation pertaining to resident (R1), reviewed the admission agreement, and observed (2) attempted delivery notices regarding a letter that was sent by registered mail and regular USPS nmail to the faciliy on February 18, 2025. The Department was provided with a copy of the letter. The findings are as follows:

The allegation states that resident (R1) passed on January 10, 2025, and (R1's) personal belongs were removed on January 11, 2025. According to the facilities contract, a refund is given for the days remaining in the month if it was paid in advance. A full month of January rent was paid on January 1, 2025 for (R1).
*cont on 9099C-1..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
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 4
Control Number 59-AS-20250228150820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PRESTIGE ENVIRONS FOR THE AGES
FACILITY NUMBER: 315002995
VISIT DATE: 03/06/2025
NARRATIVE
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9099C-1.. LPA and Administrator reviewed the admission agreement where it states that "Advance Notice to Terminate the Admission Agreement upon death is not required". Additionally, the following is stated in the Admission Agreement, "Within fifteen (15) days after your personal property is removed from the facility, your estate or other person or entity responsible for payment of fees and charges, under this agreement, will receive a refund of any fees paid in advance covering the period after your personal property has been removed."

The Administrator indicated she spoke to (R1's) responsible person by telephone on February 17,2025 when she was out of the country and indicated she would have to review the admissions agreement before issuing a refund. In addition, the Administrator agreed with the agency and (R1's) responsible person that the monthly rent would be reduced by $1,300 because there a room vacancy at the time, and the agency could not locate another facility with a vacancy. The Administrator stated to LPA that during the signing of the admission agreement with (R1's) responsible person, it was agreed that since a Pre-Admission fee was not being charged, and the facility was paying placement agency fees, there would no refunds of any pre-paid rent monies, after (R1) passed, who was on hospice.

The Administrator stated to LPA that her understanding was that prepaid fees referred to a Pre-Admission fee, which she does not charge. The Administrator confirmed she returned to the facility on Monday, March 3, 2025 and had not received a letter from (R1's) responsible person, by regular USPS mail, while she was away. LPA observed the Administrator look through a small pile of mail during today's inspection and did not locate the letter from (R1's) responsible person. The Administrator provided LPA with (2) attempted delivery receipts left inside the mailbox, across the street. One was dated February 19, 2025 (noted as a First Attempt) and a second one was dated February 24, 2025 (noted as a final attempt) and that the letter would be returned to sender on March 6, 2025, if not picked up before then.The Administrator confirmed that (R1) passed on January 11, 2025, their belongings were removed on January 12, 2025 and January rent was paid on January 1, 2025 to cover the entire month, thru January 31, 2025.

Health and Safety Code section 1569.652(c) states the following: (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed.

Based on information obtained during the investigation, the Department find the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) citation is issued on the 9099-D page. Exit interview with the Administrator. Copy of report and appeal rights provided
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20250228150820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PRESTIGE ENVIRONS FOR THE AGES
FACILITY NUMBER: 315002995
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2025
Section Cited
HSC
1569.652(c)
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§1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds.
(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by:
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Licensee/Administrator agree to contact (R1's) responsible person to discuss payment to be made within the next (2) weeks, by 3/20/25.
Documentation to be submitted to the Department showing the refund has been made.
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Based on documentation reviewed and interviews conducted, the Licensee did not issue a refund due to (R1's) responsible person, for rent monies paid from January 13, 2025- January 31, 2025, after (R1's) belongings were removed on January 12, 2025, following their passing on January 11, 2025, which posed a health and safety risk or personal rights violation to residents in care.
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LPA provided a copy of the letter mailed on February 18, 2025 to the Administrator today.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4