306005257-12-14-2022-22-AS-SSAS-CNPSWN-20230203131436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005257
Report Date: 12/14/2022
Date Signed: 12/14/2022 04:04:10 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
05/11/2021 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210511161607

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:	01:15 PM
MET WITH:	Executive Director Chad Boeddeker		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident sustained multiple falls caused by staff neglect
Resident's oxygen was not properly administered by staff
Resident's medications are not properly administered
Staff handled a resident roughly
Resident was denied a meal
Resident's room smells of urine

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. The investigation consisted of a review of records and interviews with Administrator, Staff and Witnesses. The following was determined:

Resident #1(R1) was admitted into the facility on 11/4/20. When R1 was admitted, she needed limited care and was able to complete all her ADL's. Hospice was also initiated for her primary diagnosis. In February of 2021 R1 began requiring more care by staff. The Licensee wanted to increase R1's level of care charges. The family did not agree with the charges and there was a discrepancy between the family and the Licensee. R1 was moved from the facility on 6/6/21 by the family.

Based upon interviews and a review of records, these allegations are unsubstantiated, meaning that although the allegations may have happened or were valid, there is not a preponderance of the evidence to prove that the alleged violations 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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