330905299-5-22-2024-18-AS-EMAN-D6MTUQ-20240627150239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 330905299
Report Date: 05/22/2024
Date Signed: 05/22/2024 06:05:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2022 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220411110422

FACILITY NAME:	CREST HOME FOR THE ELDERLY		FACILITY NUMBER:	330905299
ADMINISTRATOR:	RAMASAR, OSCAR		FACILITY TYPE:	740
ADDRESS:	4460 CREST VIEW DRIVE		TELEPHONE:	(951) 736-2921
CITY:	NORCO	STATE: CA	ZIP CODE:	91760
CAPACITY:	29	CENSUS: 23	DATE:	05/22/2024
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Ghislaine Ramasar/Florence Nahin		TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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Staff did not contact authorized representative of resident injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with caregiver Florence Nahin explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews document reviews, and facility tour.

For the allegation, Staff did not contact authorized representative of resident injury.

LPA Rico conducted four (4) staff interviews, 4 out of the 4 staff stated they are responsible to contact authorized representative regarding any incidents that occurs. 2 out 4 of the staff stated that R1 did not have an injury but had reoccurring wound care on (L) knee from the clinic since 2020 and the authorized representative was informed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

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 18-AS-20220411110422

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CREST HOME FOR THE ELDERLY	FACILITY NUMBER: 330905299
	VISIT DATE: 05/22/2024

NARRATIVE

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During record review, LPA received R1 documents that indicated R1 was receiving wound care in 2020 through 2022. In addition, R1 Physician Report from 2022 also indicated R1 was receiving wound treatment (L) knee.

During interview with resident. R1 stated they did not have an injury but recalls receiving wound care on their (L) knee.

Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Administrator Ghislaine Ramasar along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC9099 (FAS) - (06/04)

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