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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005642
Report Date: 01/27/2025
Date Signed: 01/28/2025 07:56:33 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/17/2023 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20231117101241
FACILITY NAME:CROWN COVEFACILITY NUMBER:
306005642
ADMINISTRATOR:KAMESHI TAYLORFACILITY TYPE:
740
ADDRESS:3901 EAST COAST HIGHWAYTELEPHONE:
(949) 760-2800
CITY:CORONA DEL MARSTATE: CAZIP CODE:
92625
CAPACITY:97CENSUS: 59DATE:
01/27/2025
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Janette Hill- Executive Director TIME COMPLETED:
03:14 PM
ALLEGATION(S):
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Staff do not distribute residents' medications as prescribed
Staff do not ensure that a resident takes medication as prescribed
Licensee does not ensure that a skilled professional performs residents' medical care
Staff did not ensure that a resident's dietary needs were met
Staff do not maintain residents' records current
Staff do not assist a resident with showering
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analysts ( LPAs) Andrea Mendivil and Kimberly Lyman made an unannounced visit to continue complaint investigation. LPAs Mendivil and Lyman were greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on 11/17/2023 and LPA Mendivil conducted the initial visit on 11/27/2023. LPA Mendivil interviewed staff and residents and obtained copies of pertinent documents such as physicians reports, assessments and dinning menus. Regarding the allegations staff do not distribute residents' medications as prescribed, staff do not ensure that a resident takes medication as prescribed, licensee does not ensure that a skilled professional performs residents' medical care, staff did not ensure that a residents dietary needs were met, staff do not maintain residents' records current, staff do not assist a resident with showering, the investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
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 2
Control Number 22-AS-20231117101241
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CROWN COVE
FACILITY NUMBER: 306005642
VISIT DATE: 01/27/2025
NARRATIVE
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Regarding the allegation staff do not distribute residents' medications as prescribed. Interviews with 3 out of 4 residents stated they receive their medications. Interviews with staff indicated if a resident refuses they will notate it. Interviews with 2 residents stated when they have left the community their medication was still distributed to them to take.

Regarding the allegation staff do not ensure that a resident takes medication as prescribed. Based on interviews with 3 out 4 residents stated they take their medication a prescribed. The 4th resident would not answer LPAs questions about medications given. Interviews with 2 out of 2 staff indicate they provide medications as prescribed.



Regarding the allegation licensee does not ensure that a skilled professional performs residents' medical care. Based on interviews with 2 out of 2 staff indicated they do not perform medical care that is out of their job duties.

Regarding the allegation Staff did not ensure that a resident's dietary needs were met, based on interviews with 2 out of 4 residents they stated their dietary needs were met. The remaining 2 residents did not answer LPAs questions about dietary needs.

Regarding the allegation Staff do not maintain residents' records current. 2 out of 2 staff stated they keep both electronic and written records. Per LPA Mendivil's review of documents for 4 out of 4 residents all had updated documents.

Regarding the allegation Staff do not assist a resident with showering, per review 3 out of 4 residents interviewed stated they received the assistance they need with their showers. The 4th resident does not need assistance with showers. 2 out of 2 staff stated residents are given shower assistance as needed.

Therefore based on records reviewed and interviews the allegations staff do not distribute residents' medications as prescribed, staff do not ensure that a resident takes medication as prescribed, licensee does not ensure that a skilled professional performs residents' medical care, staff did ot ensure that a residents dietary needs were met, staff do not maintain residents' records current, staff do not assist a resident with showering are determined to be UNSUBSTANTIATED, meaning
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2