405850010-4-21-2023-29-AS-KBUY-CRA2ZX-20230426175103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 04/21/2023
Date Signed: 04/21/2023 11:33:48 AM

Unsubstantiated

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
04/21/2022 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20220421141830

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: 67	DATE:	04/21/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Cheryl Marsh / Administrator		TIME COMPLETED:	12:46 PM

ALLEGATION(S):

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Facility did not meet resident’s needs due to insufficient staffing
Facility did not meet resident’s dietary needs

INVESTIGATION FINDINGS:

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At 10:30am on 04/21/2023, Licensing Program Analyst (LPA) Mark Jeffries arrived at the facility to issue final findings to the allegation above to this complaint. LPA introduced himself and announced the reason for the visit. LPA met with Administrator, Cheryl Marsh and explained the reason for the visit.

As to the allegation of "Facility did not meet resident’s needs due to insufficient staffing." It was alleged due to a lack of staffing, residents were not showered for multiple days, left a resident in bed for 24 hours, and was not assisted with toileting. LPA reviewed the staff schedule and Resident 1 (R1)’s needs. It was discovered through interviews, and documentation that R1 was non-ambulatory and required two person lift to ambulate. Shower schedule documentation showed showers for R1 competed on 04/02/22, 04/05/22, 04/08/22, 04/09/22, 04/10/22, 04/12/22, 04/16/22, 04/19/22, and 04/23/22.

CONTINUED on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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 29-AS-20220421141830

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: 04/21/2023

NARRATIVE

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There were no shower refusal documents for R1 during this time period. R1 stated that they would refuse the shower if it was after breakfast time because they wanted it later in the morning, however there was no documentation of refusal during this time period. R1 stated their needs were met overall. Staff notes indicated that brief changes were completed for R1 and documented during this time period. S5 was the staff assigned to 5 of the 10 showers reviewed during this time period and stated that no showers were missed to their recollection. Residents R2 though R5 stated that they did not have an issue with showers facilitated by the facility during this time, however they did wait longer durations for care service to get showers and other needs met due to COVID staff call-offs during this time. During the months of March and April 2022, the facility was in a COVID positive status, which resulted IN staff call-offs, this resulted in longer call times for assistance and showers, however there was not enough evidence through documentation, and interviews to support showers were not given or offered or that meets were not met. Therefore, there is not enough evidence at this time to support the allegation of, “Facility did not meet resident’s needs due to insufficient staffing.” and is therefore unsubstantiated at this time.

As to the allegation of “Facility did not meet resident’s dietary needs.” It was alleged that resident was given meal tray service, but staff put it out of reach of the resident, so the resident could not eat. LPA reviewed the staff schedule and Resident 1 (R1) needs. It was discovered through documentation and interviews that R1 was non-ambulatory. Interview with R1 indicated that on the day of question specific to this allegation (04/17/2022), the dinner tray was placed to far from R1. R1 stated that they used the call button and staff was able to bring the tray, then stated that, “it didn’t bother me.” and was able to eat the meal. Pertaining to the food services, Residents 2-5 did not have any comment of the food service being not meeting their dietary needs. Based on interviews, there is not enough evidence at this time to support the allegation of, “Facility did not meet the resident’s dietary needs” and is unsubstantiated at this time.

Exit interview, report read, report singed and report provided.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

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