565801541-1-7-2023-29-AS-EPEI-CMUR4F-20230107114129

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801541
Report Date: 01/07/2023
Date Signed: 01/07/2023 11:42:05 AM

Document Has Been Signed on 01/07/2023 11:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR:	ADELAIDA G. CRUZ		FACILITY TYPE:	740
ADDRESS:	225 CRESTWOOD AVENUE		TELEPHONE:	(805) 212-8303
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY: 6		CENSUS: 6	DATE:	01/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:04 AM
MET WITH:	Alex Garcia		TIME COMPLETED:	11:50 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:04 a.m., the LPA was greeted by staff. At 10:48 a.m., the LPA spoke with the Administrator over the telephone. The Administrator was not available during the time of the visit and authorized, staff Alex Garcia to sign the report. This annual had a specific emphasis on infection control practices and procedures. At 10:30 a.m., the LPA, along with the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:28 a.m., the hot water in all the three (3) resident restrooms measured between 99.1 and 100.7-degree Fahrenheit. At 10:48 a.m., the LPA spoke with the Administrator regarding the water temperature. The Administrator stated that the water temperature will be adjusted, and a water temperature log will be completed. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:29 a.m., hot water measured at 100.5-degree Fahrenheit. Continued on LIC-809-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/07/2023 11:42 AM - It Cannot Be Edited

Created By: Emily Peraldi On 01/07/2023 at 11:13 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FINEST LIVING AT CRESTWOOD	FACILITY NUMBER: 565801541
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 3 out of 3 resident restrooms water temperature tested between 99.1 and 100.7 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/13/2023
	Plan of Correction
1 2 3 4	The Administrator agreed to adjust the water temperature and ensure it reads between 105 -120 degrees F. The Administrator will provide documentation that they have turned up the water heater temperature to CCL by 01/13/2023. Civil Penalty assessed in the amount of $250

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Kristin Heffernan

LICENSING EVALUATOR NAME:

Emily Peraldi

LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/07/2023

NARRATIVE

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COMMON AREA: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 10/30/2022. At 10:29 a.m., the smoke detectors and carbon monoxide detectors were tested and functioned properly. The LPA observed cameras in the common areas. Medications are located in a locked closet near the living room.

OUTDOOR SPACE: At 10:37 a.m., the LPA observed the back patio which has a covered outdoor area for resident use. Passageways were free and clear from obstruction.

GARAGE: The garage is attached to the house. Laundry units are located inside the garage. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the garage. There is a upstairs storage which remains inaccessible to the residents.

INFECTION CONTROL: During today’s visit, the LPA spoke with the staff regarding the facility’s infection control practices. The LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate.

Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D). Civil Penalty assessed in the amount of $250. Failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted. Today's report and appeal rights were provided via email. Civil penalties issued

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2023

LIC809 (FAS) - (06/04)

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