405850010-3-11-2025-29-AS-GHTO-DENVQW-20250311163900

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405850010
Report Date: 03/11/2025
Date Signed: 03/11/2025 04:39:43 PM

Document Has Been Signed on 03/11/2025 04:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CRESTON VILLAGE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	405850010
ADMINISTRATOR/ DIRECTOR:	ADAM BRAMWELL		FACILITY TYPE:	740
ADDRESS:	1919 CRESTON ROAD		TELEPHONE:	(805) 239-1313
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY: 130	TOTAL ENROLLED CHILDREN: 0	CENSUS: 96	DATE:	03/11/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:20 PM
MET WITH:	Administrator - Adam Bramwel		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

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On 03/11/2025 at 1:20pm, Licensing Program Analysts (LPAs) Haner-Tomasko and Jeffries conducted an unannounced Case Management visit. LPAs arrived at the facility, met with Administrator Adam Bramwell, and announced the purpose of the visit. During the investigation, LPAs reviewed relevant documents and interviewed staff and resident.

On 03/03/2025, Community Care Licensing received a self-report from the facility regarding missing medication. On 03/03/2025, Resident #1(R1) reported medications missing from their self-managed medications to Administrator Adam Bramwell. On 03/03/2025, Adam reported the incident to Community Care Licensing, the Local Long-Term Ombudsman, local law enforcement, and opened an internal investigation.

R1 is able to self-administer their medication, and keeps their medications locked in their apartment. It was alleged the narcotic Norco was missing, due to R1 keeping records of the number of pills in the bottle. The report states R1 believed 35 pills went missing in February 2025. On 2/27/2025, R1 left 3 Norco pills in a bottle at their bedside, went to dinner, and returned to find only 1 pill left. The facility was notified of the missing medications on 3/3/2025.

On 3/8/2025, Administrator submitted a supplement incident report with additional details. After discussion with R1 and R1’s responsible parties, a Ring camera was placed in R1’s room to view only the drawer where the medications were kept and posted a camera in use sign outside resident room. On 3/5/2025 around 4:20pm, R1 left their room to go to dinner. At 5:25pm, the Ring camera detected movement in the room. The video footage revealed Staff 1 (S1) open the drawer, appear to take pills from the bottle, and exit the apartment within 20 seconds. The Administrator viewed the footage and contacted law enforcement. Once law enforcement was on-site, the pill bottles were collected and examined, and was found to be missing 2 Norco pills. Law enforcement questioned S1, who initially denied taking the pills. (Continue 809-C)

Kelly Burley	TELEPHONE: (805) 562-0413
Garrett Haner-Tomasko	TELEPHONE: (805) 450-0283
	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CRESTON VILLAGE ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 405850010
	VISIT DATE: 03/11/2025

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S1 emptied their pockets and the 2 Norco pills were found on their person, along with 28 other pills of varying shapes, sizes, colors, and imprint codes. S1 refused to state where the other pills came from. S1 was arrested by law enforcement. S1 was terminated by the facility and administrator submitted documentation to remove S1's associated clearance from facility roster. Administrator stated they conducted an additional audit to ensure all residents who self-store medication had proper locking boxes. LPA recommended conducting an audit of all resident self-stored and administered medications with residents present.

LPA conducted a medication audit of 9 centrally stored residents’ narcotic medications and found (no errors/errors). Administrator conducted full medication audit of all residents’ centrally stored medications on 3/6/2025.

The following deficiencies were observed and cited from the California Code of Regulations, Title 22. Personal Rights of resident, property was not safeguarded by the facility.

Exit interview conducted. A copy of the report and appeal rights issued at the time of the visit.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/11/2025 04:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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: 03/11/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/12/2025 Section Cited CCR 87468.2(a)(25)	1 2 3 4 5 6 7	Personal Rights 87468.2....residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To protection of their property from theft or loss... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	S1 was terminated 3/5/25. Administrator will create a policy addressing the residents self-custody of medication and training to review with every new and current resident who self-store medication, and as needed moving forward. The proposed policy will be emailed to LPA on 3/12/2025.
	8 9 10 11 12 13 14	Based on interview and record review, the licensee did not comply with the section cited when S1 stole R1’s medications, which posed an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	A full medication audit of centrally stored medications was conducted on 3/6/2025. Administrator will email LPA documentation from the audit on 3/12/2025. Administrator will review facilities... (Continued LIC812).
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Kelly Burley	TELEPHONE: (805) 562-0413
Garrett Haner-Tomasko	TELEPHONE: (805) 450-0283
	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

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