405850010-4-9-2024-29-AS-KBUY-D4U26F-20240430170703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 04/09/2024
Date Signed: 04/09/2024 12:20:17 PM

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
04/04/2024 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20240404095309

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:	04/09/2024
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Administrator, Adam Bramwell		TIME COMPLETED:	01:03 PM

ALLEGATION(S):

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Staff do not ensure resident's restrooms are clean and sanitized.

INVESTIGATION FINDINGS:

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At 9:45am on 04/09/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the initial investigation to the allegation to this complaint. LPA met with Administrator, Adam Bramwell, announced who he is and the reason for the visit.
LPA conducted a facility tour, took photographs, made observations, collected and reviewed documents and conducted interviews. LPA issued final findings below:
As to the allegation of, “Staff do not ensure resident's restrooms are clean and sanitized.” It was alleged that approximately 04/03/2024, Residents in Memory Care Units bathrooms were unsanitary and unclean. On 04/09/2024, at approximately 10:50am, Administrator Adam Bramwell and LPA Jeffries conducted a visual inspection of all 14 bathrooms in the memory care unit. LPA photographed and noted that 13 of 14 bathrooms were clean and in good working order. LPA noted that the one bathroom in question was cleaned, however the floor was sticky. This was discovered to not be a sanitation issue but a floor material issue that is being addressed by the administrator. 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: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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-20240404095309

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: 04/09/2024

NARRATIVE

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On 04/09/2024, LPA Jeffries interviewed Memory Care Staff 1, 2, and 3 (S1, S2, and S3). S1-3 all stated that their job duties included cleaning restrooms as needed. S1-3 all stated that they knew they could call housekeeping on the radio if there was a need to have a residents restroom cleaned due to an immediate need. LPA noted that there was no evidence on this visit to indicated that staff do not ensure resident’s restrooms are cleaned and sanitized. LPA reviewed documentation (Job Description) of staff duties of Pegasus Senior Living for the position of Care Partner that included but not limited to, “Maintains clean, neat, comfortable, safe environment for Residents, Staff and visitors, including housekeeping services for Residents.” Which S1-3 all acknowledged in interviews on 04/09/2024. At this time, there is not enough evidence to substantiate the allegation of, “Staff do not ensure resident’s restrooms are clean and sanitized.” And is unsubstantiated at this time.

Exit interview, report read, 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: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC9099 (FAS) - (06/04)

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