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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801541
Report Date: 11/17/2022
Date Signed: 11/17/2022 04:36:56 PM

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
11/10/2022 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20221110164605
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:
11/17/2022
UNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Alice ResolmeTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Facility staff failed to safeguard resident’s personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection regarding the above allegation. The LPA met with caregivers at 10:32 AM and explained the reason for the inspection. There were two caregivers and six residents present when the LPA arrived. Administrator Aida Cruz was contacted and advised of the visit. The Administrator is currently out of town and unable to come to the facility, although the LPA was able to conduct telephone interviews with her during the visit.

Community Care Licensing Division (CCLD) received the complaint of 'Facility staff failed to safeguard resident’s personal belongings' alleging pictures were removed from Resident #1's (R1) wall without R1's permission. The LPA conducted a physical plant tour of the facility with Staff Alex Garcia. At 10:42 AM, the LPA attempted to conducted an interview with Resident #1 (R1) but R1 was unable to provide any information to the LPA at this time. Report continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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 3
Control Number 29-AS-20221110164605
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: 11/17/2022
NARRATIVE
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Report continued from LIC 9099.

The LPA conducted interviews with Staff #1 (S1) at the facility and with the Administrator on the telephone between 10:43 AM and 11:00 AM. At 11:18 AM, the LPA conducted file review.

During the physical plant tour, the LPA observed photo frames in a box in R1's bedroom. During the telephone interview with the Administrator, she stated they painted R1's bedroom about a month or two ago and removed pictures from the wall. Although, they had not got around to putting the pictures back on R1's walls. The Administrator said last week, R1's family member came over to the facility and put the pictures on the walls R1 wanted back up.

Based on the information obtained, there is sufficient evidence to support allegation of Facility staff failed to safeguard resident’s personal belongings occurred as R1's personal belongings were removed from the wall and were not put back on in a timely response. Therefore the allegation is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Report reviewed with the Administrator telephonically and the report was signed by staff Alice Resolme. A copy of the report and appeals was emailed.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20221110164605
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: 11/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2022
Section Cited
CCR
87468.2(a)(27)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(27) To keep, have access to, and use their own personal possessions,.....

This requirement is not met as evidenced by:
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The Administrator shall submit proof from R1's conservator that all R1's photos that she wants hung on the wall have been re-hung. Proof shall be submitted to CCLD by 12/01/2022.
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Based on interviews and observation, the licensee failed to comply with the section cited above, as the licensee did not ensure R1's personal possessions (photos) were returned back on the wall after painting, which is a personal rights violation to R1 in care.
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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: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3