405850010-8-19-2021-29-AS-KBUY-C7HURQ-20211005154908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 08/19/2021
Date Signed: 08/19/2021 12:49:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/27/2021 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20210527092347

FACILITY NAME:	CRESTON VILLAGE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	405850010
ADMINISTRATOR:	CHERYL MARSH		FACILITY TYPE:	740
ADDRESS:	1919 CRESTON ROAD		TELEPHONE:	(805) 239-1313
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	130	CENSUS: 79	DATE:	08/19/2021
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Administrator Cheryl Marsh		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility failed to promptly respond to resident call buttons.

Facility did not provide safe accommodations to resident.

INVESTIGATION FINDINGS:

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At 10:00am on 08/19/2021, Licensing Program Analyst (LPA) Mark Jeffries, contacted the facility by phone, the Administrator was not available. LPA obtained the COVID-19 screening by Staff 9 (S9). No positive cases and no residents displaying symptoms of COVID-19 per S9. At 10:15am LPA arrived at the facility and met with Administrator Cheryl Marsh and announced the reason for the visit. LPA collected documentation and conducted interviews.

As to the allegation of, “Facility failed to promptly respond to resident call buttons.” It was discovered through interviews and documentation that at 9:15am on 05/28/2021 R1 was interviewed and disclosed that R1 has never had an emergency while pressing R1’s call button. R1 has pressed the call button 191 times during the time frame of 04/28/2021 through 05/29/2021. R1 did not recall having to wait a long period of time after pressing R1’s call button. Interviews with Administrator Cheryl Marsh and Health Welfare Director (HWD) indicated that the staff would occasionally forget to clear call button calls.
CONTINUED on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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 29-AS-20210527092347

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CRESTON VILLAGE ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 405850010
	VISIT DATE: 08/19/2021

NARRATIVE

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At 10:50am on 08/19/2021, LPA interviewed R2 and R3, both R2 and R3 deny having to wait on call button responses. Both R2 and R3 state they have only used their call buttons in emergencies and the times they had to use them there was no abnormal waiting for staff response. Administrator conducted staff training on clearing call buttons prior to LPA’s initial visit on 05/28/2021. Based on the interviews and documentation the allegation of “Faculty failed to promptly respond to resident call buttons.” Is unsubstantiated at this time.

As to the allegation of, “Facility did not provide safe accommodations to resident.” It was discovered through direct observations and interviews that R1’s room and bathroom had no items in disrepair or broken. At 9:10am on 05/28/2021, LPA and Business Office Manager (BOM) conducted a physical inspection of R1’s room; LPA tested the shower pressure, it was good; the water temperature was with in regulations. LPA checked to ensure all safety handles were securely attached to the walls. LPA did not observe any broken shower or bathroom parts. LPA observed that the commode was firmly anchored to the floor. LPA and BOM did not observe any safety hazards or disrepair items in R1’s room at the time of inspection. Interviews of R1 and staff did not reveal any hazards or disrepair items, therefore the allegation of, “Facility did not provide safe accommodations to resident.” Is unsubstantiated at this time.

Exit interview, report singed, report emailed.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC9099 (FAS) - (06/04)

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