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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005257
Report Date: 09/15/2022
Date Signed: 09/15/2022 05:42:57 PM

Document Has Been Signed on 09/15/2022 05:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
306005257
ADMINISTRATOR:DALE WOYTEKFACILITY TYPE:
740
ADDRESS:351 EAST PALM DRIVETELEPHONE:
(714) 528-4990
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY: 138TOTAL ENROLLED CHILDREN: 0CENSUS: 78DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Robert Jakini, Executive DirectorTIME COMPLETED:
05:50 PM
NARRATIVE
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This case management is in reference to complaint control number 22-AS-20211231164336. LPA met with Robert Jakini, Executive Director and explained the purpose of the visit.

On January 10, 2022, the facility was cited as the only elevator in the main building was broken for several times since October 2021. On January 10, 2022, the elevator was still broken. Mr. Jakini stated that meals were being delivered to those who are unable to walk down the stairs from the second floor. Mr. Jakini stated that four to five residents were provided the choice to move down to the first floor because these residents were using wheelchairs.

It makes it difficult for these residents when the sole elevator in the building is not working properly. Several residents were isolated to their room and were unable to dine in the dining room or go out into the facility or community.

As a result, the following deficiency is cited today as per Title 22 of the California Code of Regulations:

An exit interview was conducted, appeal rights provided and discussed and a copy of this report was given to the Administrator.
Sheila SantosTELEPHONE: (714) 703-2838
Kathrina ChinTELEPHONE: (714) 703-2840
DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2022 05:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
09/19/2022
Section Cited
CCR
80072(a)(2)

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80072 Personal Rights (a)...each client shall have personal rights which include … (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by: Based on observation and documents, the licensee did not provide a safe and comfortable environment for four
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Robert Jakini, Executive Director that the elevator was repaired on the same when there were issues.
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to five residents who were restricted to staying in their rooms and the second floor since the elevator was broken on various days from 10/2021 to 1/2022. Resident on wheelchairs on the second floor were unable to go out into the facility or community which poses a possible health and safety and personal rights risk to persons 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: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
LIC809 (FAS) - (06/04)
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