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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801541
Report Date: 11/15/2024
Date Signed: 11/15/2024 01:49:20 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 Martha Arroyo
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:
11/15/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Adelaida CruzTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff is sleeping during shift.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. The initial visit was conducted on 01/19/2024 by LPA B. Balisi. On today's visit, LPA Arroyo met with Administrator, Adelaida Cruz. Entrance interview.

During the initial visit on 01/19/2024, LPA Balisi conducted a plant tour, interviewed staff, residents, and reviewed and obtained copies of pertinent documents at approximately 10:30 a.m.

It was alleged that staff is sleeping during shift. It was reported that Staff #1 (S1) was sleeping on the couch on 01/11/2024. Information obtained during the course of the investigation reflected that S1 was indeed sleeping during their shift at the facility while they were supposed to be caring for R1.

Report Continued on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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 3
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: 11/15/2024
NARRATIVE
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Report Continued from LIC 9099...

Additionally, LPA obtained photos which reflected S1 sleeping on the couch on the morning of 01/11/2024. Furthermore, interviews conducted with residents revealed that they have previously observed S1 sleeping on the couch multiple times while living at the facility. LPA attempted to contact S1 however, was unable to do so given S1 is no longer employed at the facility. Based on the information obtained and reviewed, the Department has sufficient evidence to support the allegation of “staff is sleeping during shift”. Therefore, this allegation is being deemed Substantiated at this time.

Exit interview conducted. Report was reviewed, copy of report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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: 11/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/22/2024
Section Cited
CCR
87468.2(a)(4)
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In addition to the rights listed in Section 87468.1, residents…shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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The licensee will review and write a statement of understanding of regulations 87468.1 and 87468.2 and submit to CCL no later than 11/22/2024.
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This requirement is not met as evidenced by:

Based on record review and interviews, the licensee did not comply with the section cited above, as S1 was sleeping during their shift, which posed an immediate health and safety risk to residents 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: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3