405850010-4-9-2024-29-AS-KBUY-D5GTRY-20240521145820

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 04/09/2024
Date Signed: 04/09/2024 12:22:43 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
10/23/2023 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20231023105727

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:	11:43 AM
MET WITH:	Administrator, Adam Bramwell		TIME COMPLETED:	01:34 PM

ALLEGATION(S):

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Facility staff billed resident for services not rendered.

Facility staff mismanaged resident medication.

INVESTIGATION FINDINGS:

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At 9:45am on 04/09/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final findings to the allegations to this complaint. LPA met with Administrator, Adam Bramwell, announced who he is and the reason for the visit.
As to the allegations of, “Facility staff billed resident for services not rendered.” It was alleged that R1 was billed for services not rendered during the months of July through August 2023. It was discovered through interviews on 10/26/2023, LPA Jeffries conducted a phone interview of Family Member 1 (F1) that Resident 1 (R1) had been billed for the month of June for two different levels of care (Level 1 and level 2), also had not been provided access to at least 2 staff assisted showers per week after 06/01/2023, and a refund due of medication that was discontinued by R1’s Physician, that had been recorded after the Physicians discontinued order. On 10/26/2023, LPA Jeffries interviewed facility staff 2 (S2) who presented documentation of billing statement from 07/01/2023 through Octobers final billing statement. S2 explained that a higher level of care was assessed for R1 by S1 on 06/01/2023,
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)

Page: 1 of 3

Control Number 29-AS-20231023105727

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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additionally there was a Care Conference Acknowledgement meeting on 06/01/2023 with S1, R1, and over the phone, F1, to address the change in level of care and charges associated with the higher level of care. Due to the billing cycle of the facility uses for charging residents, both levels 1 and 2 of care were billed in the month of June 2023 without being pro-rated. The refund for the prorated amount for the change in care in question was reimbursed to R1/F1 on the Octobers billing statement. Interviews with Staff 3-6 (S3, S4, S5 and S6), indicated that R1 had verbally denied shower assistance on more than one occasion. There is no written record of shower refusal, however, all three care staff who were tasked to shower R1 stated similar denial of showers by R1. With respect to the medication refund, there was a medication order from the R1’s physician to “put a hold” on the medication in question on 06/06/2023. That medication was then discontinued by the physician on 06/23/2023 by fax from R1’s physician. The medication discontinue order by R1’s Physician was sent to Omni Care (the company handling the pharmacy order) on the same day 06/23/2023. Omni care sent the medication despite the discontinued order. In an interview with S1, S1 stated that Omni Care refused to rerun the missed ordered medication. S1 stated that they informed F1 that they would pay for that month’s medication if Omni Care refused to reimburse R1/F1. On 02/12/2023 LPA interviewed F1 by phone a second time. F1 stated that they did receive a prorated bill amount in October 2023 for June 2023 double billing of levels of care. F1 stated that they were unaware of R1’s refusals of showers. F1 stated that they did not follow up on the medication refund because of the passing of R1 and the minimal amount of the medication charge. Based on interviews, documentation, and admissions, there is not enough evidence to support the allegation of, “Facility staff billed resident for services not rendered.” 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: 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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Control Number 29-AS-20231023105727

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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As to the allegation of, “Facility staff mismanaged resident medication.” It was alleged that the facility ordered medication for R1 that had been discontinued. On 10/26/2023, LPA Jeffries reviewed documentation provided by the facility of R1’s physician order on a prescription dated 06/06/2023. The prescription order read “hold medication” meaning, do not administer the medication, starting 06/06/2023. LPA reviewed a fax from R1’s new physician on 06/23/2023 ordering the DC (discontinue) of the specific medication for R1. LPA interviewed S1 on 10/26/2023, where S1 stated that they faxed the DC order to Omni Care (the company handling the pharmacy order). Due to the timing of the order (3 working days) the medication was filled by Omni Care. S1’s stated that they attempted to return the DC ’ed medication to Omni Care, however Omni Care refused. S1 stated as a gesture of good faith, S1 offered to reimburse F1 (R1) the cost of the medication, if they also had attempted to get a refund due to Omni Cares oversight on the Physicians DC order of 06/23/2023. S1 stated that they never heard back from F1 about the medication refund from F1 contacting Omni Care. LPA observed the facilities medication destruction order for this medication in question for the remainder of the June prescription 06/07/2023- 06/30/2023, and the medication destruction order for the July order. LPA noted that the facility acted in due diligence with regards to handling of the medication in question. On 02/12/2023 LPA interviewed F1 by phone a second time. F1 stated that they did not follow up on the medication refund because of the passing of R1 and the minimal amount of the medication charge. At this time there is not enough evidence to support the allegation of, “Facility staff mismanaged resident medication.” and in 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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