306006198-12-24-2024-22-AS-MSTC-DDG7ZS-20250131210648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006198
Report Date: 12/24/2024
Date Signed: 12/24/2024 11:12:35 AM

Unsubstantiated

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
10/15/2024 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241015084244

FACILITY NAME:	CRESTAVILLA		FACILITY NUMBER:	306006198
ADMINISTRATOR:	STEPHEN W PRATT		FACILITY TYPE:	740
ADDRESS:	30111 NIGUEL RD		TELEPHONE:	(760) 804-5900
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	250	CENSUS: 198	DATE:	12/24/2024
		UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Norma Martinez		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Resident was not allowed to use the telephone.
Facility did not respect residents visitation wishes.
Facility did not allow resident to have their mail.

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and Edward Kim for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPAs met with Memory Care Director (MCD) Norma Martinez and explained the reason for today’s inspection. Administrator (AD) Myra Aragones was not present during the inspection.

The investigation into the allegations that a resident was not allowed to use the telephone, the facility did not respect residents visitation wishes, and the facility did not allow resident to have their mail revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed AD, Memory Care Director (MCD) Norma Martinez, residents, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, an Unusual Incident Report dated October 10, 2024, Resident #1’s (R1) Care Notes dated September 9, 2024, R1’s Letter dated February 9, 2024, R1’s Visitation Log for 2024, and R1’s Care Notes dated April 6, 2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 12/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024

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-20241015084244

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: CRESTAVILLA	FACILITY NUMBER: 306006198
	VISIT DATE: 12/24/2024

NARRATIVE

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Regarding the allegation that a resident was not allowed to use the telephone: it was alleged that on October 9, 2024, R1 requested to use a telephone, facility staff told R1 “we don’t have the legal authority to let you use the phone”, R1 protested, and R1 was eventually allowed to use a telephone two hours later. LPA interviewed AD and MCD who denied the allegation, stating that R1 was allowed to use the telephone whenever they wanted and would use it often to call a family member. Regarding the alleged two-hour delay on October 9, 2024, AD and MCD stated that immediately after R1 requested to use a telephone, another resident had a serious fall in the garden which required 911, R1 was advised that once the emergency was resolved staff would be available to assist R1 to use a telephone and R1 agreed without complaint, and once the emergency was resolved and staff were available to assist, R1 was immediately assisted to use a telephone less than forty minutes after R1 had originally requested to use a telephone. LPA reviewed an Unusual Incident Report dated October 10, 2024, which corroborated that a serious fall occurred on October 9, 2024, which required 911 at the same time R1 requested to use a telephone. LPA requested the facility’s telephone logs, but was advised by MCD that the facility does not log phone calls made by residents. LPA reviewed R1’s Care Notes dated September 9, 2024, which documents another recent call between R1 and a family member and per AD the facility does not document all calls residents make and R1 makes calls to their family member frequently. LPA interviewed R1 who stated that this is the only incident involving access to a telephone and that R1 was provided access to a telephone shortly after requesting it. LPAs interviewed 20 residents who did not provide information corroborating that the facility is not providing residents access to a telephone when requested. The information obtained did not corroborate that the facility denied R1 use of a telephone or intentionally delayed assisting R1 to use a telephone.

Regarding the allegation that the facility did not respect residents visitation wishes: it was alleged that on October 9, 2024, the facility allowed two family members to visit R1 at the facility, R1 reacted violently and did not want to see these family members, and R1 had previously made their wishes known to the facility that they did not want these family members to visit R1 at the facility. LPA interviewed R1, who has cognitive and mental health diagnoses, who stated that they told the facility from the very beginning that they did not want any visitors except one specific individual and that their visitation wishes were violated on October 9, 2024, but could not remember any other violations of their visitation wishes. LPA interviewed one witness, R1’s family member, who corroborated R1’s statement and stated that the facility allowed visitors against R1’s wishes multiple times.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 12/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241015084244

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: CRESTAVILLA	FACILITY NUMBER: 306006198
	VISIT DATE: 12/24/2024

NARRATIVE

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LPA interviewed AD and MCD who denied the allegation, stating that R1 never voluntarily communicated that they wanted the facility to deny visitors without being coached to do so by their family member and that when R1 did communicate their wishes regarding visitation, the facility followed them. Specifically, AD stated that during meetings with R1 and their family member, R1’s family member would coach R1 to tell AD that they did not want other family members visiting them by making that statement and having R1 repeat it, but AD did not take these statements as R1’s voluntary wishes. The facility provided R1’s Letter dated February 9, 2024, which was not directed to the facility itself, but states that R1 only wishes to see one family member. However, per MCD, R1 gave them the letter and stated it had nothing to do with the facility and was for an outside purpose and only requested that MCD hold the letter for R1. Interviews with R1’s conservator, R1’s family member, AD, and MCD revealed allegations of undue influence against multiple family members of R1. The information obtained was conflicting regarding whether R1’s visitation wishes were freely communicated to the facility. Per AD and MCD, the facility does not exclude individuals from the premises unless there is a restraining order and with regards to visitation, the facility’s policy is to ask residents each time whether they would like to meet with a visitor and to follow the resident’s decision during each visitation. When interviewed, R1’s conservator stated there are no restraining orders in place. Regarding R1’s family members being present at the facility on October 9, 2024, AD and R1’s conservator stated that this was not a visit and these family members were present at the request of R1’s conservator to facilitate R1 being moved out of the facility. LPA reviewed R1’s Visitation Log for 2024 which documents that, other than on October 9, 2024, the only other visit by R1’s other family members occurred on April 5, 2024. Per R1’s Care Notes dated April 6, 2024, during the April 5, 2024, visit, a family member visited R1, R1 communicated their wish not to see this family member, and facility staff followed R1’s request and escorted the family member out of the facility. LPAs interviewed 20 residents who did not corroborate that the facility is not respecting their visitation wishes. The information obtained did not corroborate the allegation because the facility took reasonable measures to follow R1’s visitation wishes by asking R1 if they would like to see each visitor that requested to see R1 and followed R1’s communicated wishes.

Regarding the allegation that the facility did not allow resident to have their mail: it was alleged that R1 has been receiving mail and legal service at the facility, but the facility has not been giving these documents to R1 and R1 has not received their mail for two years. One witness interviewed stated that they, along with R1, had a meeting with MCD during which they requested R1’s mail, but MCD called R1’s conservator and did not provide R1 their mail.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 12/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241015084244

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: CRESTAVILLA	FACILITY NUMBER: 306006198
	VISIT DATE: 12/24/2024

NARRATIVE

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LPA interviewed AD and MCD who denied the allegation, stating that R1 does not receive mail at the facility so the facility does not have any mail to give to R1 and that all of R1’s mail goes directly to R1’s conservator. Per MCD, R1 did receive legal service at the facility, the facility does not get involved with legal service but MCD did escort the process server to R1’s room, R1 received their legal papers and asked the facility to keep them for R1, and MCD provided these legal papers back to R1 when requested. LPA interviewed R1 who did not provide information corroborating the allegation. LPA interviewed R1’s conservator who stated they receive R1’s mail on R1’s behalf when appropriate and they do not know of any mail R1 should be receiving that they are not receiving. LPAs interviewed 20 residents who did not corroborate that the facility is withholding residents’ mail. The information obtained is conflicting.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 12/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024

LIC9099 (FAS) - (06/04)

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