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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005257
Report Date: 06/02/2022
Date Signed: 06/02/2022 09:12:42 AM


Document Has Been Signed on 06/02/2022 09:12 AM - 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:138CENSUS: 94DATE:
06/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Robert JakiniTIME COMPLETED:
09:25 AM
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
Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of following-up on the case management visit dated May 17, 2022. LPA met with Executive Director (ED) Robert Jakini and discussed the purpose of the visit.

Based on the report received by department indicated that Resident 1 (R1) rights were violated alleging that Staff 1 (S1) hit R1 in the face with an open hand. Interviews were conducted with R1 who stated they were not hit. Interviews were conducted with S1 who stated that they did not hit R1. Interviews were conducted with staff 2 (S2) who stated no personal rights violations were observed.

Based on the information gathered and interviews conducted, there is not enough evidence to corroborate that the incident occurred as reported.

There were no deficiencies cited during visit. An exit interview was conducted, and a copy of this report was left at the facility
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1