405850010-2-15-2024-29-AS-KBUY-D4U28A-20240430171000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 02/15/2024
Date Signed: 02/15/2024 05:23:03 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
06/01/2023 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20230601115306

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: 74	DATE:	02/15/2024
		UNANNOUNCED	TIME BEGAN:	09:57 AM
MET WITH:	Administrator, Adam Bramwell		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not respond to call bell in a timely manner.
Facility does not provide adequate food service.

INVESTIGATION FINDINGS:

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At 9:57am on 02/15/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final finding to this complaint and in a separate report conduct the annual facility inspection. LPA met with Interim Administrator, Adam Bramwell announced who he is and the reason for the visit.
As to the allegation of, “Staff do not respond to call bell in a timely manner.” It was discovered through documentation and interviews that R1’s call bell record from this facility indicated that between the days of April 8th, 2023, through June 8th, 2023, R1’s call pendent was pressed 87 times, during that time there were a total of 5963 total calls at the facility from an average of 60 residents who have call pendants. R1’s 87 calls represent less than .02% of total calls during that time period. Of those 87 calls, 42 calls (48% of R1’s calls) took longer than 10 minutes for facility staff to respond. This included the following call time responses: one call response time of over 50 minutes, one of over 40 minutes, four of over 30 minutes, eleven of over 20 minutes, twelve over 15 minutes, and thirteen calls of over 10 minutes that it took facility staff to respond to R1’s call pendant once it was pressed by R1. 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: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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 4

Control Number 29-AS-20230601115306

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: 02/15/2024

NARRATIVE

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Interviews of Staff 1 – 4 (S1, S2, S3, and S4) on 06/08/2023, all stated that there is not enough staff to fully attend to all resident needs. Based on call times, interviews, and documentation there is sufficient evidence to conclude that the facility, during the time of this investigation, did not have staff sufficient in numbers to provide services necessary to meet resident’s needs and the allegation of, “Staff do not respond to call bell in a timely manner.” Is substantiated at this time.

As to the allegation of, “Facility does not provide adequate food service.” It was discovered through interviews, documentation, and observations that food service at the facility on three specific weekends of May 20/21, May 27/28, and June 03/04, dining services were delivered cold and below basic standards meal offerings. In interviews on 06/08/2023, of staff 3-6 (S3, S4, S5, S6, and S7) all stated that lead staff (S2) working weekends was not properly trained and did not have enough head cook experience to manage basic food service during these dates. In interviews of Residents on 06/08/2023 R2, R4, R5, and R6 stated that the food service has been cold on the weekends during the May through June of 2023 time period. Based on interviews of Staff and Residents, at this time there is enough evidence to support the allegation of, ““Facility does not provide adequate food service.” and is substantiated at this time.

Exit interview, report read, deficiency cited, 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: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
06/01/2023 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20230601115306

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: 74	DATE:	02/15/2024
		UNANNOUNCED	TIME BEGAN:	09:57 AM
MET WITH:	Administrator, Adam Bramwell		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Residents room not being clean properly.

INVESTIGATION FINDINGS:

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As to the allegation of, “Residents room not being clean properly.” It was alleged that R1's room was not being properly cleaned. It was discovered through interviews that R1’s trash was often full or overflowing of trash. On 06/08/2023, LPA Jeffries conducted a facility tour, and entered 6 different resident rooms. LPA noted that all rooms were on this date properly cleaned. On 06/08/2023, LPA interview R1. R1 stated that the staff do a good job and their rooms is cleaned every day. R1 stated that they fill their trash can up and the staff do a good job of emptying their trash can daily. LPA interviews with R2 through R6 did not find any complaints of rooms not being cleaned properly. At this time there is not enough evidence to support that allegation, of “Residents room not being cleaned properly” and is unsubstantiated at this time.

Exit interview, report read, and report provided.

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: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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 4

Control Number 29-AS-20230601115306

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: 02/15/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/29/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs. … This requirement was not met by the number of call response	1 2 3 4 5 6 7	During time of complaint investigation facility employed contract staff due to low staffing. Current staffing meet or exceed standards to meet current resident census needs.
	8 9 10 11 12 13 14	times with R1 that exceeded 10 minutes which poses a potential risk to residents in care.	8 9 10 11 12 13 14
Type B 02/29/2024 Section Cited CCR 87555(b)(9)	1 2 3 4 5 6 7	87555 General Food Service Requirements (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement	1 2 3 4 5 6 7	During the time of this complaint facility employed staff that did not have adequate training. At the time this LIC9099-D was singed kitchen staff have proper training and POC is met.
	8 9 10 11 12 13 14	was not met by evidence of Resident and Staff interviews verifying cold meals were served on serval occasions, which poses a potential risk to residents in care.	8 9 10 11 12 13 14

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 Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC9099 (FAS) - (06/04)

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