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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801541
Report Date: 12/15/2022
Date Signed: 12/16/2022 08:25:53 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
11/07/2022 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20221107150416
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: 5DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Benedicto MallariTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Facility staff fail to safeguard residents’ belongings from damages
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to deliver final findings to the above facility. LPA met with staff member at 11:30 a.m. who was authorized to sign the report. Administrator Adelaida Cruz was not able to join LPA Ascencio during visit.

On 11/07/2022, the Department received a complaint alleging that regarding facility staff failed to safeguard the resident’s belongings from damages. On 11/08/2022, LPA Ascencio conducted a facility tour starting at 11:48 a.m. At 12:17 p.m., Resident #1 (R1) room was observed to have rat droppings underneath a red sofa chair and inside the walk-in closet. At the time, LPA did not observed damages to R1’s personal belonging. Interview with R1’s Family member, on 12/01/2022 starting at 9:35 a.m. revealed that the sole of R1’s shoe was eaten by rodents inside the home. R1’s family stated they mentioned this to staff members, but staff were not fazed by the news of rodents and damages to R1’s shoe. R1’s family added that even though the rats ate the sole of the shoes, the shoe is usable and is currently still being used by R1.
Continued on LIC 9099 - C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
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-20221107150416
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: 12/15/2022
NARRATIVE
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On 12/15/2022, starting at 11:39 a.m., LPA Ascencio observed R1’s left shoe having been eaten at the toe of the foot, and heel, while the left shoe had more damages that included heel of the shoe and toe area of the shoe. Staff members stated they are not sure what happened to the shoes but they are placed now on top of the filling cabinet to prevent further damages.

Based on interviews and observation, the allegation facility staff failed to safeguard the resident’s belonging from damages is substantiated at this time.

1 citation was issued during today's visit. Pursuant to Title 22, Division 8, Chapter 8 of the California Code of Regulations, the following deficiencies were cited. ( Refer to LIC 9099 - C)

Exit interview conducted. Copy of the report, and appeal rights provided to Admin via email.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20221107150416
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: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2022
Section Cited
CCR
87217(b)
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87217 Safeguars for Resident Cash, Personal Property, and Valuables (b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff.
This requirement is not met as evidenced by:
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Admin will provide R1's family member a new pair of shoes of equal value. Admin will send LPA the proof of purchase by 12/30/2022.
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Based on interviews and observation, the licensee did not comply with the section cited above as R1's personal property was not safeguarded by the facility which poses a potential health, safety and personal rights rist to person 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3