330905299-1-31-2023-56-AS-NBRN-CNPVYQ-20230203155128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 330905299
Report Date: 01/31/2023
Date Signed: 01/31/2023 01:18:57 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2023 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230125102155

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:	92860
CAPACITY:	29	CENSUS: 20	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Florence Nahin, Caregiver		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff are not allowing residents to smoke
Staff are not allowing residents to buy cigarettes
Resident being charged for services that are not being provided

INVESTIGATION FINDINGS:

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This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA) is to initiate the 10 day visit to investigate the above-mentioned complaint allegations.

During the course of this investigation LPA interviewed two (2) staff at the facility and interviewed the licensee via telephone. LPA discussed the nature of the alleged violations with licensee and staff. LPA learned that (12) of (20) residents are smokers. LPA interviewed five (5) residents that are smokers. Investigation revealed the following: Staff and resident interviews confirm that smoking was discontinued approximately three weeks ago. Four (4) of five (5) residents interviewed report that they provide staff with money to purchase their cigarettes. Staff and resident interviews confirm that staff buy cigarettes for residents that smoke, however, residents have not been allowed to smoke or provided with cigarettes or provided an opportunity to purchase cigarettes for approximately three weeks.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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 3

Control Number 56-AS-20230125102155

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: CREST HOME FOR THE ELDERLY	FACILITY NUMBER: 330905299
	VISIT DATE: 01/31/2023

NARRATIVE

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It has been the practice of the facility to allow smoking according to the licensee. This change was only to be temporary during inclement weather. Five (5) of five (5) residents interviewed report that they make requests to smoke and are denied access. This is a violation of resident rights.

We have substantiated the complaint allegations as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with, and furnished to the facility representative. Please see LIC 9099D.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 56-AS-20230125102155

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: CREST HOME FOR THE ELDERLY	FACILITY NUMBER: 330905299
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/01/2023 Section Cited CCR 87468.2(a)(6)	1 2 3 4 5 6 7	Personal Rights: To make choices concerning their daily lives in the facility. The facility failed to meet this requirement as evidenced by the facility refusing residents that smoke access to cigarettes.	1 2 3 4 5 6 7	Licensee to provide LIC 9098 verifying review and understanding of the regulation section cited by POC due date.
Type A 02/01/2023 Section Cited CCR 87468.2(a)(12)	1 2 3 4 5 6 7	Personal Rights:To wear their own clothes; to keep and use their own personal possessions, including their toilet articles; and to keep and be allowed to spend their own money.	1 2 3 4 5 6 7	Licensee to provide LIC 9098 verifying review and understanding of the regulation section cited by POC due date.
	8 9 10 11 12 13 14	The facility failed to meet this requirement ass evidenced by failure to provide residents access to the cigarettes they purchased.	8 9 10 11 12 13 14
Type B 02/01/2023 Section Cited CCR 87468(12)(c)	1 2 3 4 5 6 7	A facility may assess a separate charge for an item or service only if that separate charge is authorized by the admission agreement...Review of admission agreements do not include documentation of additional service charge of purchasing cigaretts for the residnets.	1 2 3 4 5 6 7	Licensee to provide LIC 9098 verifying review and understanding of the regulation section cited by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

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