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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330905299
Report Date: 04/13/2022
Date Signed: 08/03/2023 03:18:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2021 and conducted by Evaluator Amy Goldenberg
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210824140156
FACILITY NAME:CREST HOME FOR THE ELDERLYFACILITY NUMBER:
330905299
ADMINISTRATOR:RAMASAR, OSCARFACILITY TYPE:
740
ADDRESS:4460 CREST VIEW DRIVETELEPHONE:
(951) 736-2921
CITY:NORCOSTATE: CAZIP CODE:
91760
CAPACITY:29CENSUS: 19DATE:
04/13/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Oscar and Ghislaine RamasarTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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-Staff did not address a resident's change in medical condition
-Staff did not ensure a resident hygiene needs were met while in care
-Staff deny a resident from speaking to authorized representative
INVESTIGATION FINDINGS:
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This unannounced visit conducted by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegations mentioned above.

During the course of the investigation, interviews were conducted with R1, with staff, and a review of R1's record was completed. Copies of pertinent documents obtained by LPA. LPA learned the following information: It is alleged that staff did not address R1's diaper rash and that staff did not ensure residents hygiene needs are being met. During interview R1 admits that she sometimes refuses assistance, but also reports that staff will not give them help when they ask. Two (2) of two (2) staff interviewed revealed that R1 is scheduled to receive a shower using a shower chair daily but will refuse often.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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 18-AS-20210824140156
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CREST HOME FOR THE ELDERLY
FACILITY NUMBER: 330905299
VISIT DATE: 04/13/2022
NARRATIVE
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 It is alleged that staff deny resident from speaking to authorized representative. R1 denies this allegation. During LPA visit on 08/26/2021 R1 was using the phone. R1 reports knowing how to contact their representative. Two (2) of two (2) staff interviewed report that the facility phone is available to residents for making personal calls.

Based on the available information, we have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2