405850010-6-8-2023-29-AS-KBUY-CT7QMN-20230627121748

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 06/08/2023
Date Signed: 06/08/2023 12:42:06 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, 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
02/21/2023 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20230221102902

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: 68	DATE:	06/08/2023
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Cheryl Marsh / Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are overcharging a resident while in care.

INVESTIGATION FINDINGS:

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At 9:01am on 06/08/2023, 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 in care.” 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 (for example, Level of Care increase) 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, thus charging a full month for both services. 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. The facilities billing system ultimately will resolve billing issue in no more than two billing cycles. CONTINUED on LIC9099-C

Substantiated

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: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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-20230221102902

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: 06/08/2023

NARRATIVE

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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. Additionally, the residents bill has an overdue amount in three time frame sections at the bottom of the billing form that indicates the amount of time there is with a past due amount, which can be inaccurate based on the initial monthly overcharging amount before prorated and credited amount. 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 and the bill reflects a past due amount, placing an inaccurate past due amount on the residents bill at the bottom of the bill. Based on the initial monthly overcharge the allegation of, “Facility overcharging residents in care.” Is substantiated at this time.
The same type of allegation was addressed and cited on Case# 29-AS-20221109110234 during the same time period investigated, subsequently there will be no LIC9099-D for this report, see referenced case report for deficiency and plan of correction..

Exit interview, report read, appeal rights 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: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 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
02/21/2023 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20230221102902

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: 68	DATE:	06/08/2023
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Cheryl Marsh / Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are not providing an authorized representative access to a resident's personal records.
Staff are not following the admission agreement.
Staff are not properly trained.

INVESTIGATION FINDINGS:

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As to the allegation of, “Staff are not providing an authorized representative access to a resident’s personal records.” It was discovered that R1 moved into this facility on 10/03/2022 with a LIC602A (8/11) (Physicians Report) that indicated that R1 had full capabilities of self-care and medication management, signed on 09/15/2022. It was discovered through interviews of F1 on 02/27/2023, that R1 moved into the facility on R1’s own volition, and there was a Power of Attorney (POA) record for R1 identifying F1 and F2 as full health care POA’s for R1 dated 06/04/2019. This POA did not state any oversight pertaining to financial responsibilities, only health care. F1 requested billing records from facility. In interview with S1 on 03/02/2023 indicated that the facility was working to provide F1 paperwork for financial records upon the authorization of R1. At the time of the interview on 03/02/2023 F1 had access from the facility to R1’s records.

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: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20230221102902

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: 06/08/2023

NARRATIVE

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However, based on documentation of LIC602 (Physicians Report) showing that R1 had full capabilities of self-care and medication management, and the POA only covered health related oversight, the facility acted in due diligence according to releasing R1’s financial information to F1 at the time this complaint was filed. Based on documentation and interviews the allegation of, “Staff are not providing an authorized representative access to a resident’s personal records.” is unsubstantiated at this time.

As to the allegation of, “Staff are not following the admission agreement.” It was alleged that the facility was not notifying R1’s responsible party for billing and care assessment and changes in level of care billing and dietary assessments. On 03/10/2023 and 03/20/2023, LPA reviewed documentation including LIC602A (8/11) Physicians Report, singed and dated 09/15/2022, Facilities semi annual evaluations signed and dated 12/13/2022, 01/06/2023, and 03/15/2023, and Facilities dietary orientation form dated 10/03/2022. R1’s LIC602A (8/11) (Physicians Report) that indicated that R1 had full capabilities of self-care and medication management, signed on 09/15/2022. It was discovered through interviews of F1 on 02/27/2023, that R1 moved into the facility on R1’s own volition, and there was a Power of Attorney (POA) record for R1 identifying F1 and F2 as full health care POA’s for R1 dated 06/04/2019. The facilities first semi annual evaluation report was facilitated to F1 by phone conference and email follow up for Power of Attorney (F1). The facilities second semi annual evaluation report was signed by R1 and in accordance with R1’s LIC602A (Physicians Report) also signed by R1 on 01/06/2023, and R1’s third semi annual evaluation was emailed to F1 on 03/15/2023. LPA interviewed S1 on 03/02/2023 and indicated that the facility was working to provide F1 paperwork for financial records upon the authorization of R1. At the time of the interview on 03/02/2023 F1 had access from the facility to R1’s records. However, based on documentation of LIC602 (Physicians Report) showing that R1 had full capabilities of self-care and medication management. Based on documentation, interviews, and email confirmations there is not enough evidence at this time to support the allegation of “Staff are not following the admissions agreement.” and is unsubstantiated at this time.

CONTINUED on LIC9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 29-AS-20230221102902

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: 06/08/2023

NARRATIVE

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As to the allegation of, “Staff are not properly trained.” It was alleged that R1 was not properly assessed for dietary restrictions based on R1’s LIC602A (8/11) which indicated that R1 had a special diet of, “Low concentrated sweets, regular.” This information was also in resident file and additionally located in the kitchen available for review to all kitchen staff and Food Service Director (S7). On 11/17/2022, S7 provided LPA with a tour of the kitchen and resident dietary screening procedure. LPA observed R1’s admissions “Dietary Order/Information” dated 10/03/2022 indicating LCS (Low Concentrated Sweets) diet. LPA noted that the residents dietary oversight procedure was simple to follow and understandable. LPA reviewed the following documentation: “Crandell Corporate Dietitians Assisted Living Quarterly Audit” dated 09/15/2022, conducted by Registered Dietitian Jo Bergstrom with certification from Commission on Dietetic Registration (#708490) expiring 08/31/2026 for executive oversight and regulation requirements. The kitchen is operated on a daily basis by S7 who has 8 years of Executive Chief experience and Associates of Science Degree from California Culinary Academy - Food Services (June 1997). Additionally, all facility kitchen staff have training that meet regulation standards. LPA noted that interview with F1 on 02/27/2023 had a concern with R1 having a box of chocolate in their room. LPA noted LIC602A that indicated that R1 had full mental capacity, able to make own decisions for all health care needs and the box chocolate was a personal choice by R1 and not a reflection of the level of staff training. There is not enough evidence at this time to support the allegation of, “Staff are not properly trained.” and is unsubstantiated at this time.

Exit interview, report read and provided.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

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