405850010-3-11-2025-29-AS-KBUY-DF7NXE-20250328105101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850010
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:14:45 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
11/20/2024 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20241120103550

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:	03/11/2025
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Administrator, Adam Bramwell		TIME COMPLETED:	03:27 PM

ALLEGATION(S):

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Staff do not ensure that resident's incontinence needs are being met.
Staff do not ensure that residents are assisted with bathing.
Staff do not respond to resident's call for assistance.
Staff are not assisting residents with medications in a timely manner.
Staff did not respond to resident's fall.

INVESTIGATION FINDINGS:

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At 1:20pm on 03/11/2025, Licensing Program Analysts (LPA’s) Jeffries and Haner-Tomasko arrived unannounced to deliver the final findings to all the allegations to this complaint. LPAs also conducted a subsequent case management visit on a report not related to this complaint during the same visit. LPAs met with Administrator, Adam Bramwell, announced who they are and the reason for the visit.
As to the allegations of, “Staff do not ensure that resident's incontinence needs are being met.” and “Staff do not ensure that residents are assisted with bathing. “ It was alleged that Resident 1’s (R1) hair, and clothes were covered in own fecal matter and incontinence was not regularly changed by facility staff. It was discovered through observation and interviews on 11/21/2024 LPA Jeffries conducted a physical tour of facility memory care unit. LPA observed R1’s room to be clean and free of odor. LPA also attempted to interview R1 on 11/21/2024 however R1 interview did not result in a response to any of the questions asked. LPA also toured 4 resident rooms next to and across from R1’s rooms all clean in good repair and no odor. On 01/23/2025 LPA conducted a second physical inspection of R1’s room and person and noted no
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: 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.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241120103550

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: 03/11/2025

NARRATIVE

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obvious neglect of incontinence care. On 01/21/2025 LPA Jeffries conducted interviews with Staff 1 – 4 (S1, S2, S4, S4) all stated that R1 has incontinence issued with “digging” and are always addressed by staff when observed and as needed. LPA reviewed facility care plan for R1 that shows two showers per week. At this time there is not enough evidence to support the allegations of. “Staff do not ensure that resident’s incontinence needs are being met.” And “Staff do not ensure that residents are assisted with bathing. “ both are unsubstantiated at this time.
As to the allegations of, “Staff do not respond to residents call for assistance.” and “Staff are not assisting residents with medications in a timely manner. “It was alleged that R2 was yelling “Help me” and no staff responded. It was discovered through documentation, observations, and interviews that on 11/21/2024 LPA conducted a physical tour of facility and observed R2 in their room. R2 was vocal during the LPA observation stating “lord help me” LPA observed S4 attending to R2’s needs. On 11/21/2024 LPA Jeffries conducted an interview with S4 who stated that R2 baseline is continually requesting staff assistance by calling out or yelling for staff. S4 stated that Staff check on all residents, including R2 approximately every 15 minutes or less. Interviews on 11/21/2022 with S1, S2, S3, and S4 all stated that residents are continually checked for any changes in conditions of residents. All stated they have high confidence in all staff and no staff are neglecting residents needs. On 11/21/2024 LPA Jeffries attempted to interview R1, R2, R3, and R4 all stated they feel safe in facility, however none answered screening questions when LPA was checking cognitive understanding. On 11/21/2024 LPA Jeffries reviewed R1 and R2’s Physicians reports, Centrally Stored Medication Records (CDMR), and Medication Administration Records (MAR)and found no abnormalities. At this time there is not enough evidence to support the allegations of, “Staff do not respond to residents call for assistance.” and “Staff are not assisting residents with medications in a timely manner. “ and are both 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: 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

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241120103550

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: 03/11/2025

NARRATIVE

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As to the allegation of, “Staff did not respond to resident's fall.” It was alleged that approximately between October 28 through November 3 of 2024 an unknown resident had fallen, and no staff assisted the resident. On 11/20/2024, 11/21/2024, and 11/23/2024 LPA Jeffries attempted to contact the reporting party (RP) by phone with no answered. As of 03/10/2025 there has been to return call from RP. On 11/21/2024 and 11/27/2024 LPA Jeffries reviewed facility serious incident reports (SIRs) which reviled the following: On 10/25/2024 a resident fell in their room, pressed pendant and staff address fall; accordingly, there was no other recorded resident fall in the time period of the alleged fall and there were no subsequent reports of resident injury within that time frame of the alleged fall. At this time there is not enough evidence to support the allegation of, “Staff did not respond to resident's fall.” 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: 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

LIC9099 (FAS) - (06/04)

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