<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005257
Report Date: 02/07/2023
Date Signed: 02/07/2023 03:30:18 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
07/14/2021 and conducted by Evaluator Michelle Reed
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210714121848
FACILITY NAME:CRESCENDO SENIOR LIVINGFACILITY NUMBER:
306005257
ADMINISTRATOR:DALE WOYTEKFACILITY TYPE:
740
ADDRESS:351 EAST PALM DRIVETELEPHONE:
(714) 528-4990
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:138CENSUS: 89DATE:
02/07/2023
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Chad BoeddekerTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was moved without resident’s consent.
Resident was placed with a roommate without resident’s consent.
Resident was left in a room without personal belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Michelle Reed made an unannounced visit to the facility for the purpose of presenting the findings of this complaint investigation. Upon arrival, LPA met with Administrator Chad Boeddeker. The complaint was investigated and consisted of interviews with the facility staff, Administrator and witnesses. The following was determined:

Resident #1(R1) was admitted into the facility on 1/29/21. R1 resided in Assisted Living. On 2/18/21 R1 was moved to the Memory Care community due to confusion and the need for more care. According to staff interviewed R1’s responsible party was told that R1 would be moving to a shared setting and would eventually have a roommate.

On 6/17/21, the Wellness Coordinator contacted the responsible party and informed that R1 would be moved to a shared room. According to staff interviewed the responsible party agreed verbally to the change. R1’s responsible party denies such agreement. Records reviewed did not disclose a signed
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
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 22-AS-20210714121848
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
VISIT DATE: 02/07/2023
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
agreement to the change. There is no documentation that R1 would be in a shared room. R1 was moved and R1 was placed with a roommate that he did not get along with.

On 6/22/21 at the request of the responsible party, R1 was moved with another roommate. Responsible party was informed that she would have to pay for a private room if R1 did not want a roommate.

On 6/24/22 R1 contacted his responsible party and told her he was being moved again and was upset as he could not find his clothes and he was in a room by himself.

On 6/26/21 R1’s responsible party visited R1 and noted that he did not have all his personal possessions in his room and staff did not know where the possessions were. The possessions were eventually found in the other two rooms R1 had been moved to. On 6/27/21 R1 moved from the facility.

Based upon interviews with staff and records reviewed, the preponderance of standard evidence has been met and the allegations are substantiated.

See LIC9099D for cited deficiencies.

An exit interview was conducted and a copy of this report and appeal rights were given to Chad Boeddeker

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20210714121848
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: 02/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/08/2023
Section Cited
CCR
87468.2(a)(17)
1
2
3
4
5
6
7
Additional Personal Rights of Residents in Privately Operated Facilities All residents in privately operated residential care facilities for the elderly shall have personal rights: to share a room with a person of their choice when both residents live in the facility and both consent to the arrangement.
1
2
3
4
5
6
7
Licensee/Administrator agree to obtain written consent from family member/residents before moving residents from room to room to avoid a personal rights violation. Proof of understanding will be provided via certification
8
9
10
11
12
13
14
This requirement was not met as evidenced by:

R1 and responsible party did not want R1 to share a room and facility staff moved R1 to a shared room without consent.
8
9
10
11
12
13
14
Type A
02/08/2023
Section Cited
CCR
87468.1(a)(12)
1
2
3
4
5
6
7
Personal Rights of Resident’s in all facilities- All residents in privately operated residential care facilities for the elderly shall have personal rights: To wear their own clothes; to keep and use their own personal possessions, including their toilet articles. This requirement was not met as evidenced by


1
2
3
4
5
6
7
Licensee/Administrator agree to move all resident belongings when a resident moves rooms to avoid a personal rights violation. Proof of understanding will be provided via written certification.
8
9
10
11
12
13
14
R1 was moved three times within a 10 day period and all his personal belongings were not moved with him. Several of his belongings were left in the rooms that he moved from (clothes, hamper, toothbrush, toothpaste, hair brush, dresser).

8
9
10
11
12
13
14
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 SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
07/14/2021 and conducted by Evaluator Michelle Reed
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210714121848

FACILITY NAME:CRESCENDO SENIOR LIVINGFACILITY NUMBER:
306005257
ADMINISTRATOR:DALE WOYTEKFACILITY TYPE:
740
ADDRESS:351 EAST PALM DRIVETELEPHONE:
(714) 528-4990
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:138CENSUS: 89DATE:
02/07/2023
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Chad BoeddekerTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not properly trained
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Michelle Reed met with Administrator Chad Boeddeker to deliver the findings of this complaint allegation.. The complaint allegation was investigated and consisted of interviews with the facility staff, Administrator and witnesses. The following was determined:

LPA reviewed records for the staff involved in the complaint allegations. The facility uses a training program called Relias. Staff received dementia training through this program.

Based upon the 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 it occurred with staff involved in the moving of R1.

An exit interview was conducted with Chad Boeddeker and a copy of this report was provided.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4