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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801541
Report Date: 11/10/2022
Date Signed: 11/14/2022 08:34:03 AM

Substantiated


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
11/08/2022 and conducted by Evaluator Kelly Dulek
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20221108142907
FACILITY NAME:FINEST LIVING AT CRESTWOODFACILITY NUMBER:
565801541
ADMINISTRATOR:ADELAIDA G. CRUZFACILITY TYPE:
740
ADDRESS:225 CRESTWOOD AVENUETELEPHONE:
(805) 212-8303
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:6CENSUS: 6DATE:
11/10/2022
UNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Adelaida (Aida) CruzTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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Staff do not dispense medication as prescribed
Staff do not assist resident with grooming
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegations listed above. LPA arrived at the facility at 11:02AM and initially met with facility staff. Licensee was contacted via telephone and indicated she would arrive at the facility shortly. Licensee Adelaida (Aida) Cruz arrived at 11:55AM. Entrance interview conducted.

During today's visit, LPA toured the facility with Staff #1 (S1) at 11:22AM, attempted resident interviews between 11:26AM and 11:40AM, conducted staff interviews at 11:44AM, 01:40PM, and 01:59PM, conducted a medication audit for Resident #1 (R1) at 12:21PM, reviewed relevant documents at 1:10PM, and interviewed Licensee throughout the visit. The following was then determined:

It was alleged that staff do not dispense medications as prescribed. A medication audit was conducted for R1's prescribed medications at 12:21PM. The medication list initially given for LPA to review was dated
REPORT CONTINUED ON LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
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 6
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
11/08/2022 and conducted by Evaluator Kelly Dulek
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20221108142907

FACILITY NAME:FINEST LIVING AT CRESTWOODFACILITY NUMBER:
565801541
ADMINISTRATOR:ADELAIDA G. CRUZFACILITY TYPE:
740
ADDRESS:225 CRESTWOOD AVENUETELEPHONE:
(805) 212-8303
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:6CENSUS: 6DATE:
11/10/2022
UNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Adelaida (Aida) CruzTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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9
Staff feed resident less than three meals per day
Staff isolate resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegations listed above. LPA arrived at the facility at 11:02AM and initially met with facility staff. Licensee was contacted via telephone and indicated she would arrive at the facility shortly. Licensee Adelaida (Aida) Cruz arrived at 11:55AM. Entrance interview conducted.

During today's visit, LPA toured the facility with Staff #1 (S1) at 11:22AM, attempted resident interviews between 11:26AM and 11:40AM, conducted staff interviews at 11:44AM, 01:40PM, and 01:59PM, conducted a medication audit for Resident #1 (R1) at 12:21PM, reviewed relevant documents at 1:10PM, and interviewed Licensee throughout the visit. The following was then determined:

It was alleged that staff feed resident less than three meals per day. During today's visit, when LPA arrived at the facility, there were five (5) residents sitting at the dining table eating. Two (2) staff were present at the
REPORT CONTINUED ON LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20221108142907
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: FINEST LIVING AT CRESTWOOD
FACILITY NUMBER: 565801541
VISIT DATE: 11/10/2022
NARRATIVE
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table feeding two (2) of the residents. Shortly after LPA's arrival, one of the staff retrieved a tray with empty plate from a resident room. LPA observed most of the food was consumed while residents were at the dining room table and left the table once their plates and bowls were mostly empty. Licensee showed LPA text messages from the facility staff showing the resident meals for the past 3 days and a note with the amount consumed by each resident. Interview with staff and residents revealed that all residents come to the table for meals and eat their meals together at the table, with the exception of one resident who chooses to eat lunch and dinner in their room. Staff provide assistance with feeding 2 of the residents at the dining room table during meal time. Staff interview revealed that sometimes R1 does become tired during mealtime. When R1 becomes tired at the meal, staff indicated it is unsafe to continue to feed R1, due to choking risk, so they will feed R1 an Ensure drink when this happens. Staff interview also revealed that R1 does finish most meals, and they feed R1 first to try to avoid R1 becoming tired during their meal. Based on interview and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation that "staff feed resident less than 3 meals per day" is deemed UNSUBSTANTIATED at this time.

The complaint also alleges that staff isolate resident, indicating R1 is left in their room with the door closed. Upon arrival at the facility, LPA observed 5 of 6 residents all seated at the dining table, including R1. After lunch time, LPA observed R1 remained in the common area of the facility for approximately 30 minutes following lunch before being brought to their room to rest. LPA observed other residents in the common areas throughout the visit. LPA also observed doors to resident rooms to remain open during today's visit. Interview revealed that residents are allowed to remain outside their rooms or with their bedroom doors open, unless they are resting or as needed for resident privacy during direct care. Based on interview and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; therefore the allegation that "staff isolate resident" is deemed UNSUBSTANTIATED at this time.

No citations issued for these allegations. Exit interview conducted. A copy of the report was provided via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20221108142907
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: FINEST LIVING AT CRESTWOOD
FACILITY NUMBER: 565801541
VISIT DATE: 11/10/2022
NARRATIVE
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Continued from LIC 9099...
11/26/2021. Current Medication Administration Record (MAR) and Centrally Stored Medication record were reviewed for November 2022. Record review revealed that staff were utilizing a medication list from 11/26/2021 to determine which medications R1 is prescribed and to order medications. However, R1 has been under hospice care since 07/21/2022 and the medication list for the period of 09/22/2022-11/20/2022 contains different medications prescribed. Interview revealed that R1 only takes 2 regularly scheduled medications, however the list provided by hospice indicates daily medications Hydroxine hydrochloride, Multivitamin, Trazodone hydrochloride. None of these regularly prescribed medications were present at the facility during today's visit. Additional medications listed as PRN (as needed) Ativan 0.5mg, Betamethasone dipropionate, Lactulose, Levsin 0.125mg, Zophran 4mg were not present at the facility. Interview also revealed that R1's Docusate Sodium was unable to be administered due to waiting on the prescription for delivery. MAR indicated the Docusate Sodium was administered only once on 11/10/2022, however the prescription label is dated 11/07/2022, was divided between two bubble packs and had 3 softgels removed from the bubble packs. Medication review also revealed that R1 has multiple medications ordered as needed (PRN), however, there is no documentation from the physician regarding the parameters by which to administer PRN medications or if R1 is able to determine the need for PRN medication. MAR review revealed R1 has not taken any PRN medications during November 2022, the time period observed. Based on interview and record review, the allegation that "Staff do not dispense medication as prescribed" is deemed SUBSTANTIATED at this time.

The complaint also alleges that facility staff do not assist with grooming. Staff interview revealed that R1 receives showers once a week with the hospice shower aide. Staff provide additional showers for R1 if needed. Facility staff shower other residents, however there are two (2) who refuse showers. Shower refusal is not documented, nor is there a process for informing residents' responsible party in the event of a refusal. Regarding additional hygiene needs, interview revealed that toenails are only cut by a podiatrist and due to scheduling conflicts with the current provider, this service has been unable to be provided as of late. Licensee indicated she plans to change to an alternate provider to remedy the situation, but hasn't yet. LPA observed Resident #2 (R2) to have long toenails and R2 stated they cannot cut their own. One resident has a mobile manicurist who visits the resident at the facility, but the other residents do not receive this service. Licensee will inquire as to whether R1's responsible party will allow for this service to be provided. Interview revealed that R1 does wear gloves to limit scratching. Hospice nurse was able to recently assist in trimming Report Continued on LIC 9099-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20221108142907
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: FINEST LIVING AT CRESTWOOD
FACILITY NUMBER: 565801541
VISIT DATE: 11/10/2022
NARRATIVE
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Continued from LIC 9099-C...
R1's nails. Record review revealed that R1 does require assistance with grooming and hygiene needs. Based on interview and observation, the allegation that "staff do not assist resident with grooming" is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted with Licensee Aida Cruz. Today’s reports and appeal rights were reviewed and provided via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20221108142907
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: FINEST LIVING AT CRESTWOOD
FACILITY NUMBER: 565801541
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/28/2022
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
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Licensee agreed to complete a medication audit of R1's medications with hospice to ensure all medications are accounted for on the MAR, centrally stored record, and present in the facility. Additional training will be provided to staff by a qualified professional and training will be completed
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Based on interview and record review, the licensee did not comply with the above cited section, as R1's medications were not administered as prescribed, as they were not present in the facility, which poses an immediated health risk to residents in care.
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 and record of trainingwill be sent to CCL by POC due date.
Type A
11/28/2022
Section Cited
CCR
87464(f)(4)
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87464 Basic Services (f) Basic services shall at a minimum include:(4) Personal assistance and care as needed by the resident... and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports
This requirement is not met as evidenced by:
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Licensee indicated that shower refusals will be documented going forward and that R1's nails were recently trimmed. Licensee will inquire with R1's Responsible Party whether R1 can have regular manicure care. Licensee will also change podiatrist providers and schedule service. Licensee
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Based on interview and observation, the licensee did not comply with the above cited section, as residents observed did not have their nails and toenails appropriately groomed and showers refusals are not regularly documented, which poses an immediate health risk to residents in care.
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will inform CCL by POC due date of the next scheduled podiatrist visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6