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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 05/24/2023
Date Signed: 05/25/2023 11:58:43 AM

Substantiated


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
11/09/2022 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20221109110234
FACILITY NAME:CRESTON VILLAGE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
405850010
ADMINISTRATOR:CHERYL MARSHFACILITY TYPE:
740
ADDRESS:1919 CRESTON ROADTELEPHONE:
(805) 239-1313
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:130CENSUS: 68DATE:
05/24/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cheryl Marsh /AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility overcharging residents.

Facility posted photos of residents on social media.
INVESTIGATION FINDINGS:
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 At 10:00am on 05/25/2023, Licensing Program Analyst (LPA) Jeffries arrived at the facility to deliver final findings to the allegations to this complaint. LPA, met with Administrator Cheryl Marsh, announced who he was and the reason for the visit.

As to the allegation of, “Facility overcharging residents.” It was discovered through interviews, documentation, and observation that the facility has two independent financial oversight programs that need to communicate with each other to ultimately resolve resident monthly billing. In interviews with Administrator and S1 it was discovered that when a new resident service is added the facilities billing system will add that service to that month’s billing, and it will not prorate or remove the replaced service until the next billing cycle. The following billing cycle will resolve the added service by crediting and/or prorating the added service and the service it replaced (if applicable). This billing resolution can take up to two billing cycles to resolve some billing issues.
CONTINUED on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
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 5
Control Number 29-AS-20221109110234
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: 05/24/2023
NARRATIVE
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The facility billing system ultimately will resolve billing issue in no more than two billing cycles. However, there is no indication on the residents billing statement that the newly added service will be prorated, which caused a temporary over billing when services are added during the billing cycle. The facility overcharges the new service without explanation of how it gets resolved and because there is no explanation the resident receives a bill for the wrong amount for that month. Based on the initial monthly overcharge the allegation of, “Facility overcharging residents.” Is substantiated at this time.

As to the allegation of, “Facility posted photos of residents on social media.” It was discovered through photographs, and interviews that on 10/10/2022, photographs of R1 and R2 were posted to the facilities Facebook page. Both R1 and R1 had singed the facility's likeness of release form, stating that they did not wish to share their image to be published. LPA observed photographs of images. LPA interview Administrator on 10/27/2022 where it was stated that they acknowledged the photographs were posted on Facebook by mistake and were removed “a few days later.” Based on photographs and interviews the allegation of “Facility posted photos of residents on social media.” Is substantiated at this time.


Exit interview, citation and technical violation issued, appeal rights and report provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 29-AS-20221109110234
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
87507(g)(G)and(H)
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87507(g) Admission agreements shall specify ...:(G) A comprehensive description of billing and payment procedures.(H) A provision indicating that an itemized monthly statement that lists all separate charges incurred by the resident that are collected by the facility shall be provided to the
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Administrator shall provided an addendum to admission agreement outlining the billing procedures with an acknowledgment from resident or resident representative of billing process. And work with Licensee to rectify the technical monthly over billing charges.
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resident or the resident’s representative, if any. This requirement was not met by evidence of monthly over billing of reporting parties and poses a potential danger to residents in care.
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 Administrator will provided addendum and update to LPA by 06/09/2023.
Type B
06/08/2023
Section Cited
CCR
87468.2(a)(2)
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87468.2(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents ... shall have all of the following personal rights: (2) To have their records and personal information remain confidential and to approve their release, except
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Administrator will provide 100% of staff a 1 hour training of resident personal rights that include instruction on regulation 87468.2. Administrator will submit list of staff that attended training and the course materials to LPA by 06/08/2023.
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as authorized by law. This requirement was not met by evidence of photographs posted on Social Media (Facebook) of R1 and R2, where R1 and R2 both signed facility's likeness of release, not to release form which poses a potential risk to residents in care.
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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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
11/09/2022 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20221109110234

FACILITY NAME:CRESTON VILLAGE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
405850010
ADMINISTRATOR:CHERYL MARSHFACILITY TYPE:
740
ADDRESS:1919 CRESTON ROADTELEPHONE:
(805) 239-1313
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:130CENSUS: 68DATE:
05/24/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cheryl Marsh /AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility did not notify authorized representative of resident being assessed by staff.

Facility falsely advertised food items.

Food being served to residents is not of quality.

Resident's chart notes are inaccurate.
INVESTIGATION FINDINGS:
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 As to the allegation of, “Facility did not notify authorized representative of resident being assessed by staff.” It was discovered through interviews with Administrator, and Staff 1-6 that resident general assessments are conducted on a daily basis by staff as to ensure resident health and safety. Administrator interview on 10/27/2022 stated, more comprehensive resident assessments are conducted when daily observations indicate a need for resident reassessment. S2 conducted a comprehensive resident evaluation on R1 August 18, 2022. At that time, a recommendation by S2 in their assessment faxed to R1’s primary care physician was a Physician Order Request, however R1’s primary care Physician did not agree with assessment and did not change R1’s LIC 602 that was dated 03/27/2022. During that assessment period R1’s spouse was the authorized representative, however on October 24, 2022, R1’s spouse passed away. Additionally, there was a care plan meeting with Facility staff, R1, R1’s spouse and current responsible parties.
CONTINUED on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20221109110234
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: 05/24/2023
NARRATIVE
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Based on documentation, and interviews, there is not enough evidence to support the allegation of, “Facility did not notify authorized representative of resident being assessed by staff.” and is unsubstantiated at this time.

As to the allegations of, “Facility falsely advertised food items.” and “Food being served to residents is not of quality.” It was alleged through photographs that spinach and asparagus was not of quality at the facility. LPA conducted interviews with Residents 1 – 6 who all stated that the food at the facility has never been spoiled or rotten to their knowledge. R1 stated that they “didn’t like the choices but they are a picky eater.” R2 stated there are enough food choices that are of good quality but there is always someone who is not going to like the food.” LPA observed diet assessment for R1 conducted on 06/03/2022 that stated, “regular diet”. LPA interview S7 stated that the facility receives two shipments of food each week and fresh fruits and vegetables are always verified by S7 or staff to be fresh before serving to residents. LPA conducted visits on 10/27/2022, 11/17/2022, and 03/02/2023, food always appeared to be of good quality. LPA reviewed the facilities advertisement for dining and LPA found food to be of same quality as pictured as in web based advertisement. Based on interviews, observations, and documentation there is not enough evidence to support the allegation of, “Facility falsely advertised food items.” and “Food being served to residents is not of quality.” and are unsubstantiated at this time.

As to the allegation of, “Resident's chart notes are inaccurate.” It was alleged that R1’s chart notes had indicated that R1 observation by staff were inaccurate. On 11/17/2023, LPA interviewed Staff 1 -7. S1- S7 all indicated that R1 had some difficulty in dining and navigating throughout the facility when spouse was not present. S1 -S7 all so concurred that R1 had no challenges with dining and navigating throughout the facility when spouse was present. Interviews conducted on 11/17/2023 represent same findings as chart notes. Based on documentation of chart notes and staff 1-7 interviews there is not enough evidence to support the allegation of, “Resident's chart notes are inaccurate.” and is unsubstantiated at this time.


Exit interview, report read, report singed and report provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5