306006019-9-17-2024-22-AS-AORZ-D9AQUU-20240920122919

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006019
Report Date: 09/17/2024
Date Signed: 09/17/2024 02:50:30 PM

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
09/13/2024 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20240913154738

FACILITY NAME:	CRESCENT LANDING AT GARDEN GROVE MEMORY CARE		FACILITY NUMBER:	306006019
ADMINISTRATOR:	LOPEZ, DARLENE		FACILITY TYPE:	740
ADDRESS:	11848 VALLEY VIEW STREET		TELEPHONE:	(419) 247-2800
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92845
CAPACITY:	72	CENSUS: 47	DATE:	09/17/2024
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Jessica Martinez and Vanessa Nunez		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not provide transportation to resident
Staff mishandled resident medications
Resident did not receive medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA toured the facility and interviewed staff and resident as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegations that resident did not receive medication as prescribed, staff mishandled resident medications and staff did not provide transportation to resident, the investigation revealed the following: When Resident 1 (R1) admitted into the facility on 10/20/2023, resident was not prescribed phenobarbital. Resident confirms admitting into facility without the prescription for phenobarbital. Resident admitted into the facility post skilled rehab. Resident was prescribed phenobarbital 100mg 1/2 tab twice daily effective 01/15/2024. The prescription was adjusted effective 08/30/2024 to 60mg 1 tab twice daily. LPA audited the resident's medications during the visit and medications are being administered per physician order. R1 requested facility to take the resident to the Department of Motor Vehicles to obtain a copy of the resident's drivers license. Facility has denied the request citing a responsibility only to assist residents with health related appointments. CONTINUED ON LIC 9099C DATED 09/17/2024

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: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

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-20240913154738

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 GARDEN GROVE MEMORY CARE	FACILITY NUMBER: 306006019
	VISIT DATE: 09/17/2024

NARRATIVE

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Department regulations require Licensees to assist with arranging for medical or dental care appropriate to the needs of the resident. Per physician report dated 10/16/2023, the resident is diagnosed with Alzheimer's Dementia with Psychosis and Epilepsy. Based on interviews conducted and record review, the allegations are deemed unfounded, meaning the allegations were 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: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

LIC9099 (FAS) - (06/04)

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