306006019-10-15-2024-22-AS-AORZ-DA6M26-20241018091301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006019
Report Date: 10/15/2024
Date Signed: 10/15/2024 02:45:43 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
10/07/2024 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20241007161459

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: 51	DATE:	10/15/2024
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Kyle Coleman		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not meeting clients dietary needs
Staff are not properly addressing pest infestation in facility
Facility staff are not keeping the facility at a comfortable temperature for
residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff and resident as well as reviewed and obtained pertinent documentation such as facility menu. Regarding the allegations that facility staff are not meeting clients dietary needs, facility staff are not keeping the facility at a comfortable temperature for resident and staff are not properly addressing pest infestation in facility, the investigation revealed the following: Resident 1 (R1) has an order for double portions at meal time and confirms receiving double portions. R1 stated dissatisfaction with certain meals while admitting there are other choices to choose from if the main meal is not to the resident's liking. Two out of two staff confirm resident receives double portions as well as variable choices. During the visit, LPA observed temperature in the resident's room is 72 degrees F and temperature reading throughout the facility read 73 degrees. CONTINUED ON LIC 9099C DATED 10/15/2024.

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: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 22-AS-20241007161459

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: 10/15/2024

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
26
27
28
29
30
31
32

Resident confirms temperature is usually 75 degrees F which the resident states is too hot. Department regulations state rooms shall be between 68 and 85 degrees F. Administrator indicates that the AC is operational and has had no issues with operating. Resident stated that on one occasion there were ants on the resident's pillow. LPA observed no ants in the resident's room. Maintenance Director indicated spraying outside the resident's window for ants when it was brought to his attention. Maintenance Director denies seeing any ants in the resident's room. LPA observed the area outside the window and did not observe any ants there either. Per physician report dated 10/16/2023, resident is diagnosed with Alzheimer's Dementia with psychosis. 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: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2