306006018-8-10-2023-22-AS-AORZ-CURRKT-20230816130600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006018
Report Date: 08/10/2023
Date Signed: 08/10/2023 11:42:32 AM

Unfounded

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
08/07/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20230807092836

FACILITY NAME:	CRESCENT LANDING AT SANTA ANA MEMORY CARE		FACILITY NUMBER:	306006018
ADMINISTRATOR:	TORRES, JUDITH		FACILITY TYPE:	740
ADDRESS:	3730 S. GREENVILLE AVENUE		TELEPHONE:	(419) 247-2800
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	72	CENSUS: 42	DATE:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Myra Martin and Carrie Hartman		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff are not adequately providing supervision to a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the visit, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as medication orders and medication administration record. Regarding the allegation that staff are not adequately providing supervision to a resident while in care, the investigation revealed the following: During the tour of the facility, LPA observed five caregivers, one med tech and Health Services Director on-site during the visit. Facility schedule indicates the same staffing level for second shift as well. Health Services Director works Sunday-Thursday, 8-5 PM. Licensing regulations do not require a nurse to be on-site at licensed facilities. Resident 1 (R1) admitted into Hospice care on 08/02/2023. Resident is prescribed Olanzapine 2.5 MG, generic for Zyprexa as of 08/03/2023. Hospice notes indicate resident was prescribed Zyprexa for behaviors as resident is diagnosed with Advanced Dementia. Once medication administration for Olanzapine started, CONTINUED ON LIC 9099C DATED 08/10/2023

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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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Control Number 22-AS-20230807092836

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: CRESCENT LANDING AT SANTA ANA MEMORY CARE	FACILITY NUMBER: 306006018
	VISIT DATE: 08/10/2023

NARRATIVE

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R1 was put on an Interim Service Plan which indicates to caregivers that there has been a change in medication which may have side effects. This alerts the caregivers to be mindful of resident change in condition or medication side effects. Caregivers sign acknowledgement of the Plan and it is kept in the caregiver's binder. Facility provided a copy of the plan to LPA. Resident was started on a low dosage of Olanzapine and is being monitored by physician and Hospice. LPA observed R1 relaxing in the facility during the visit. Based on observations and interviews conducted, the allegation is deemed UNFOUNDED, meaning the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of this report was provided to facility representative.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

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