306005257-12-14-2022-22-AS-SSAS-CN32DA-20230113161757

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005257
Report Date: 12/14/2022
Date Signed: 12/14/2022 03:52:48 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/28/2020 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201228134414

FACILITY NAME:	CRESCENDO SENIOR LIVING		FACILITY NUMBER:	306005257
ADMINISTRATOR:	DALE WOYTEK		FACILITY TYPE:	740
ADDRESS:	351 EAST PALM DRIVE		TELEPHONE:	(714) 528-4990
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	138	CENSUS: 105	DATE:	12/14/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Executive Director (ED) Chad Boeddeker		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Resident sustained an unwitnessed fall due to lack of supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst Michelle Reed arrived at the facility to deliver the findings of this complaint investigation. Upon arrival, LPA met with Executive Director Chad Boeddeker.

Resident #1(R1) was admitted into the facility on 9/30/18. R1 lived in Memory Care and according to records reviewed, was independent with some of her ADL's. She needed reminders and standby assistance with bathing. R1 was nonambulatory and used a walker for ambulation. On 12/28/20 at approximately 5:30am, R1 had an unwitnessed fall in her room. R1 was found by Staff #1 with a head wound and back pain. 911 was immediately called and R1 was taken to the hospital. R1 returned to the facility on 12/29/20 with Home Health Services.

Based upon interviews conducted with staff and records reviewed, this allegation is unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to Chad Boeddeker.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

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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