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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005257
Report Date: 02/02/2023
Date Signed: 02/02/2023 02:14:38 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
01/25/2023 and conducted by Evaluator Jerome Haley
COMPLAINT CONTROL NUMBER: 22-AS-20230125093540
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: 88DATE:
02/02/2023
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Chad BoeddekerTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Resident was allowed to leave the facility unassisted multiple times
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannouced visit to intiatate the investigation into the complaint received against this facility on January 25, 2023. LPA Haley was allowed into the facility and explaind the reason for the visit upon entry. LPA Haley discussed the complaint allegation with Execurtive Director (ED) Chad Boeddeker.

Regarding the allegation: Resident was allowed to leave the facility unassisted multiple times

The investigation revealed Resident 1 (R1) left thew facility unassisted January 16, 2023 around 7:40AM, and January 19, 2023 around 3:00AM. In addition to R1 leaving the facility on two seperate occasions, on January 23, 2023 R1 was found in the parking lot of the facility after exiting the memory care unit. Interviews with ED Boeddeker and staff confirmed R1 was able to leave the facility unassisted on January 16, 2023 and January 19, 2023.
Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

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

DATE: 02/02/2023
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 3
Control Number 22-AS-20230125093540
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: 02/02/2023
NARRATIVE
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Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6, Chapter 1.

An exit interview was conducted with Executive Director Chad Boeddeker and a copy of this report and appeal rights were provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

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

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230125093540
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: 02/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2023
Section Cited
CCR
87705(b)(2)
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87705 Care of Persons with Dementia
(b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including:
(2) Safety measures to address behaviors such as wondering, aggressive behaviors and ingestigation of toxic materials.
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Executive Director Boeddeker provided a copy of the in-service training on Elopement dated January 23, 2023.
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The above requirement has not been met as evidenced by:
Interviews, and document review revealed R1 was able to leave the facility unassisted January 16, 2023 and January 19, 2023. This poses a health and safety risk to residents in care.
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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.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

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

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3