306006018-2-16-2024-22-AS-SSAS-D2N8M4-20240220213743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006018
Report Date: 02/16/2024
Date Signed: 02/16/2024 09:22:56 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
11/20/2023 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231120120513

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:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	08:28 AM
MET WITH:	Mayra Solis-Business Office Manager,Judith Torres-Administrator		TIME COMPLETED:	09:38 AM

ALLEGATION(S):

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Resident sustained unexplained injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on 11/20/23. LPA was greeted and granted entry into the facility and met with Business Office Manager (BOM) Mayra Solis. LPA explained the reason for the visit. Administrator (AD) Judith Torres arrived shortly after.

This agency has investigated the complaint alleging that resident sustained unexplained injuries while in care. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: During the investigation LPA reviewed documents including the Physician Report (LIC602A) dated 06/27/23 for Resident 1 (R1). Per Physician Report R1 has a diagnosis of Dementia and is ambulatory. Records reviewed by LPA Ramirez included the Unusual Incident/Injury Report (UIIR) dated 11/21/23 for R1. Per UIIR on 11/15/23 R1 was noted with discoloration on their left side and bruise on right hip. Per UIIR Silverado Hospice nurse came and order x-ray on left and right ribs.
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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-20231120120513

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CRESCENT LANDING AT SANTA ANA MEMORY CARE	FACILITY NUMBER: 306006018
	VISIT DATE: 02/16/2024

NARRATIVE

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During the investigation LPA reviewed documents including the Pacific Coast Medical Services x-ray dated 11/17/23 results for R1. Per Pacific Coast Medical Services R1’s findings stated no displaced fracture of ribs noted and stated rule out fracture. Records reviewed by LPA Ramirez included the Silverado Hospice Staff Communication Note dated 08/02/23-11/20/23. Per Communication Note dated 11/20/23 R1 tolerated shower and wound care well, patient calm and no rib fracture. During the course of the interviews R1’s family member reported that the bruises were not due to staff neglect and stated that staff are very caring. During the interviews, AD stated that R1 did not sustained unexplained injuries while in care and reported that R1 easily bruises. Per AD caregivers are very gentle because R1 bruises easily. During interviews with the Reporting Party (RP), RP reported that she cannot confirm if the injuries were due to staff abuse.

Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with AD Torres, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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