405850010-1-23-2025-29-AS-KBUY-DEAS2C-20250227122920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 01/23/2025
Date Signed: 01/23/2025 03:29:53 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
09/12/2024 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20240912163515

FACILITY NAME:	CRESTON VILLAGE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	405850010
ADMINISTRATOR:	ADAM BRAMWELL		FACILITY TYPE:	740
ADDRESS:	1919 CRESTON ROAD		TELEPHONE:	(805) 239-1313
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	130	CENSUS: 96	DATE:	01/23/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator, Adam Bramwell		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff inappropriately restrained resident.
Staff are not safeguarding resident's personal belongings.
Staff are not ensuring resident is showered.
Staff left resident in soiled diapers for extended period of time.

INVESTIGATION FINDINGS:

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At 9:00am on 01/23/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to issue final findings to the allegations above to this complaint as well as to conduct facility annual inspection on a separate report. LPA met with Administrator, Adam Bramwell, announced who he is and the reason for the visit.
As to the allegation of, “Staff inappropriately restrained resident.” It was alleged that an unknown date in September 2024, Staff 1 (S1), S2, and a third unidentified staff (S3) held down Resident 1 (R1). It was discovered through interviews and documentation that in interviews by Licensing Program Analyst (LPA) Jeffries, on 09/16/2025, with S1 and S2. It was discovered that R1 had had assistance with manicuring R1’s fingernails in September of 2024 by S1 and S2. Both S1 and S2 denied restraining R1 during the assistance with manicuring R1’s fingernails. S1 stated that, we both (S1 and S2) assisted R1 but no one had to restrained (R1) in doing so.” S1 did not recall who the third staff was nor a third staff assisting in the manicure of R1. S1 stated that R1’s right hand is always in a closed fist and S1 and S2 cut the nails of R1’s left hand, they attempted to cut the nails of R1’s right hand but R1 resisted. CONTINUED on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

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 3

Control Number 29-AS-20240912163515

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: 01/23/2025

NARRATIVE

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In an interview with R1 on 09/16/2024 by LPA Jeffries, R1 did not recall staff restraining R1 at any time. R1 stated that they have lived at the facility “for years”. R1 stated that they feel safe with staff and care at this facility. On 01/22/2025, LPA conducted a phone interview with R1’s Responsible party (F1). F1 stated that R1, had an undiagnosed stroke sometime in R1’s past (as told by R1’s Physician, Dr. Bettencourt) which resulted in R1’s right hand being closed. F1 stated that facility staff attempted to cut R1’s fingernails on the right hand but did not force R1. On 09/16/2024, LPA Jeffries conducted interviews with S4, S5, and S6, and all staff stated that they have never participated or have witnessed a restraint of any resident at this facility. On 09/16/2024, LPA Jeffries conducted interviews with R2, R3, R4, and R5, all stated that they have never been or seen any type of resident physical restraint at this facility. All four Residents stated that they feel safe in this facility and all staff treat them with dignity. LPA conducted a record review of incident reports for the month of September of 2024 and found no account of reported restraints or staff to resident interventions. At this time there is not enough evidence to support the allegation of, “Staff inappropriately restrained resident.” and is unsubstantiated at this time.

As to the allegation of, “Staff are not safeguarding resident’s personal belongings.” It was alleged that R1 had lost two sets of R1’s dentures. Additionally, a toothbrush that was dirty and black was found. It was discovered through interviews that on 09/16/2024, LPA Jeffries conducted interview with Facility Administrator, Adam Bramwell, who stated that R1’s Responsible Person (F1) brought to the facilities attention that R1’s dentures were missing. Administrator stated that they instructed staff to conduct a through search in memory care unit for missing dentures, but they were not found. On 01/22/2025 LPA interviewed F1, who stated that they were aware of one set of dentures being missing, they reported to the facility and the facility conducted a search but did not find the dentures. F1 also stated that R1 has had a history of hiding their dentures and sometimes throwing them into the trash and did not dismiss this possibility in this instance. F1 stated that they facility followed through in their responsibility and due diligence to locate the missing dentures. On 09/16/2024, LPA Jeffries interviewed S1, S2, S4, and S5, all had been instructed to search for missing dentures which were not found. Additionally, S1, S2, S4, and S5 were all shown a picture of the dirty black toothbrush, and all stated they had never seen that toothbrush before and would have collected it and notified supervisors if they had seen a toothbrush in that condition.

CONTINUED on LIC9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240912163515

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: 01/23/2025

NARRATIVE

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On 09/16/2024, LPA Jeffries noted on an inspection of R1’s room one clean toothbrush that appeared to show normal use which was the brand of Oral B, two unused new toothbrushes that were the brand of Colgate, all had R1’s name written on the handle of the toothbrushes, however the dirty black toothbrush, was not a brand name toothbrush nor did it have R1’s name on the handle. At this time there is not enough evidence to substantiate the allegation of, “Staff are not safeguarding resident’s personal belongings.” and is unsubstantiated at this time.
As to the allegation of, “Staff are not ensuring resident is showered.” It was alleged that R1 was not getting showers. It was discovered through interviews and documentation that on 09/16/2024, LPA Jeffries interviewed R1, who stated, “Staff take good care of me, I like the staff.” and that their (R1) needs were always met and have never had an issue with care, including bathing and incontinence. On 09/16/2024, LPA Jeffries conducted interviews with S1 and S2 who stated that showers for R1 are offered 4 times per week, and often R1 would refuse showers. S1 and S2 stated that they would let supervisor know and note in the shower refusal log when R1 would refuse shower. S1 and S2 stated that R1 would normally be showered one to two time per week on average. LPA Jeffries reviewed facility documents labeled “Shower Refusal” for R1, which shows that R1 had refused showers on 10 occasions during the time period of August 15 through September 15th of 2024 which is a refusal of 10 of 20 shower days. On 01/22/2025 LPA conducted an interview with F1, who stated that the facility will call F1 who is R1’s responsible party and notify F1 when R1 has a shower refusal. F1 stated the facility will call but not always the same day. At this time there is not enough evidence to substantiate the allegation of, “Staff are not ensuring resident is showered.” and is unsubstantiated at this time.
As to the allegation of, “Staff left resident in soiled diapers for extended period of time.” It was alleged that, facility are leaving R1 in soiled diapers for a long time. It was discovered through interviews on 09/16/2024, LPA Jeffries interviewed R1, who stated, “Staff take good care of me, I like the staff.” and that their (R1) needs were met and have never had an issue with care, including bathing and incontinence. On 09/16/2024 LPA Jeffries conducted an interview with S1, S2, S4, and S5, who all stated that residents are monitored throughout the day for incontinence and incontinence is always addressed when needed. On 01/22/2025, LPA Jeffries conducted an interview with F1 who stated, the facility dose a good job with R1’s incontinence and had never had an issue or problem with the facility addressing R1’s incontinence in a timely manner. At this time there is not enough evidence to support the allegation of, “Staff left resident in soiled diapers for extended period of time.” and is unsubstantiated at this time.

Exit interview, report read, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC9099 (FAS) - (06/04)

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