306005257-12-14-2022-22-AS-SSAS-CNPSVL-20230203131252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005257
Report Date: 12/14/2022
Date Signed: 12/14/2022 03:55:11 PM

Substantiated

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
02/18/2021 and conducted by Evaluator Michelle Reed

COMPLAINT CONTROL NUMBER: 22-AS-20210218160141

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:	11:00 AM
MET WITH:	Executive Director (ED) Chad Boeddeker		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Lack of supervision resulting in resident suffering a fall while in care.

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 9/18/20. R1 resided in Memory Care and according to records reviewed was a fall risk. R1 was nonambulatory and used a walker for ambulation. R1 would often forget to call for help and fell on at least 9 occasions during the months of October 2020-February 2021. On 2/16/21 at approximately 4:00pm, R1 had an unwitnessed fall in the hallway of the Memory Care unit. He was found by Staff #1 lying on his right side and had hit his head leaving a dent in the wall. 911 was immediately called and R1 was taken to the hospital. R1 returned to the facility on 2/19/21.

Based upon interviews with staff and a review of R1's records and incident reports, the preponderance of evidence standard has been met and the allegation is substantiated. See LIC9099D for cited deficiencies.
conducted with staff and records reviewed, An exit interview was conducted and a copy of this report was provided to Chad Boeddeker.

Substantiated

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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Control Number 22-AS-20210218160141

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CRESCENDO SENIOR LIVING	FACILITY NUMBER: 306005257
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/14/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/15/2022 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	Basic services- Basic services shall at a minimum include: Care and Supervision The facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered.	1 2 3 4 5 6 7	Licensee will ensure that there is always enough staffing to meet each residents need especially if the resident is a fall risk. Proof of understanding via certification will be provided by 12/16/22.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Licensee failed to provide supervision to R1. R1 was admitted as a fall risk and would forget to call for help. R1 had 9 falls within a 5 month period. On 2/16/21 R1 fell and received a head injury. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

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