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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801541
Report Date: 01/19/2024
Date Signed: 01/19/2024 02:29:40 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
01/12/2024 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20240112085223
FACILITY NAME:FINEST LIVING AT CRESTWOODFACILITY NUMBER:
565801541
ADMINISTRATOR:ADELAIDA G. CRUZFACILITY TYPE:
740
ADDRESS:225 CRESTWOOD AVENUETELEPHONE:
(805) 620-0739
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:6CENSUS: 4DATE:
01/19/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alice ResolmeTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not keep facility free of insects.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint visit for the allegations listed above. Upon arrival LPA met with Alice Resolme and explained the reason for the visit. Licensee Adelaida Cruz could not be onsite at this time , but was contacted during the visit and stated Alice can sign in their place.

At approx. 10:30am, LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation.

It was reported that Staff did not keep facility free of insects, as it was alleged that there is an infestation of spiders and termites in Room #3, Resident #1 (R1)'s closet. During physical plant, LPA observed spider webs and four (4) spiders along the railing of R1's closet. LPA also observed multiple spider webs in room #5. LPA did not observe any evidence of termite infestation in any room.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
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 4
Control Number 29-AS-20240112085223
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: 01/19/2024
NARRATIVE
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continued from 9099

LPA did not observe spider webs in other four (4) bedrooms. LPA's interview with two (2) out of (4) residents revealed one resident observes  spiders often, but staff are informed and they dispatch the spider immediately.  One other resident interviewed stated they have never observed spiders or termites. The other two (2) residents declined to be interviewed. Based on information gathered during the visit, the Department has sufficient evidence to determine this allegation occurred. Therefore the allegation of Staff did not keep facility free of insects has been substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D): Exit interview conducted and copy of the report and appeal rights provided to Licensee.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20240112085223
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: 01/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2024
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation - The facility shall be clean, safe, sanitary and in good repair at all times...safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by
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Staff immediatly cleared spider webs and dispatched spiders. POC cleared during the visit.
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Based on interviews and observations, the licensee failed to comply with the section cited above as evidence of spiders and spider webs were observed in multiple rooms, which poses a potential health and personal rights risk to persons 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: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4