330905299-7-25-2023-18-AS-NBRN-CURPXZ-20230816114310

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 330905299
Report Date: 07/25/2023
Date Signed: 07/25/2023 02:42:24 PM

Unsubstantiated

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
10/05/2021 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211005161237

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:	07/25/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Gigi and Oscar Ramasar, Licensee/Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained unexplained injuries while in care
Facility staff do not allow resident access to a telephone
Facility staff do not allow resident to leave the facility

INVESTIGATION FINDINGS:

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This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegations mentioned above.

Investigation included interviews with staff and resident (R1), review of records of client observation dated 9/5/2021 through 10/04/2021. Investigation revealed the following: R1 is non-ambulatory. R1 uses a wheelchair. R1 receives incontinent care. It is alleged that R1 sustained a rash while in care that were indicative of their needs not being cared for at home. Review of collected records indicate in weekly note entries dated 09/05/2021 and 9/10/2021 refusals for incontinent care and showering. During interview R1 admits that they sometimes refuse assistance.

Unsubstantiated

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: 07/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023

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-20211005161237

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: 07/25/2023

NARRATIVE

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Two (2) of two (2) staff interviewed revealed that R1 was scheduled to receive a shower using a shower chair daily but will refuse often. It is alleged that R1 is not allowed access to the phone. During interview R1 had the facility phone in their possession. They deny being refused access to the phone. It is alleged that facility staff do not allow R1 to leave the facility. Four (4) out of four (4) residents interviewed report that the facility takes residents shopping and to get food. Interview with licensee revealed that there are no activity logs maintained at the facility. Review of R1’s cash resources log revealed that R1 received monthly money for their personal use. Licensee reports that R1 did go shopping while they lived in the home but were not able to leave the facility unassisted due to conservatorship status.

Based on the available information we have found the complaint allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023

LIC9099 (FAS) - (06/04)

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