330905299-5-22-2024-18-AS-EMAN-D7PMWC-20240731095803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 330905299
Report Date: 05/22/2024
Date Signed: 05/22/2024 06:01:47 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-20220411144445

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		TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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Resident sustained injury in care.
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 Administrator Ghislaine Ramasar and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, document reviews, and facility tour.

For the allegation, Resident sustained injury in care.

LPA Rico conducted four (4) staff interviews. 4 out of 4 staff informed LPA that R1 did not sustained an injury while in care. 2 out of the 4 staff informed LPA R1 is independent but would refuse to change their clothes for a week. Due to resident's refusals R1 abdomen skin became irriated. In addition, R1 confirmed they would refuse to change their clothes. R1 also indicated they were receiving treatment for their abdomen skin but did not have an injury.

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-20220411144445

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, R1 Physician Report from 2022 indicated resident had a history of skin condition. In addition, on residents’ observation reports also indicated resident was receiving treatment in 2022.

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

During staff interview 2 out of the 4 staff indicated R1 authorized representative was informed regarding skin condition. During resident interview, R1 informed LPA that their representative was aware of her condition but no injury occurred.

During record review, LPA Rico received facility confirmation letter that was sent to authorized representative.

Based on the evidence found during the investigation, the two (2) allegations 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 along Ghislaine Ramasar 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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