<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801541
Report Date: 11/15/2024
Date Signed: 11/15/2024 01:57:18 PM

Document Has Been Signed on 11/15/2024 01:57 PM - 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 CRESTWOODFACILITY NUMBER:
565801541
ADMINISTRATOR/
DIRECTOR:		ADELAIDA G. CRUZFACILITY TYPE:
740
ADDRESS:225 CRESTWOOD AVENUETELEPHONE:
(805) 620-0739
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 6CENSUS: 4DATE:
11/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Adelaida CruzTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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) Martha Arroyo conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20240118100032). The purpose of the visit is to issue a citation for a deficiency observed during the initial complaint investigation.

During the visit on 08/01/2024, interviews conducted with the administrator and staff revealed that Resident #1 (R1) moved into Room #3 when they were admitted to the facility 04/26/2022 and stayed in the same room until they expired on 01/16/2024. Per R1’s physician’s report, dated 04/25/2022, it lists R1’s ambulatory status as bedridden. However, the facility has an approved fire clearance to have one (1) bedridden resident in bedroom #5 only. Additionally, per report, it states R1 had dementia upon admission to the facility and R1 did not have an updated yearly medical assessment and reappraisal as stated per regulation.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of the 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
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/15/2024 01:57 PM - It Cannot Be Edited


Created By: Martha Arroyo On 11/15/2024 at 12:34 PM
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: 11/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/22/2024
Section Cited
CCR
87202(a)

1
2
3
4
5
6
7
All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The licensee will review and write a statement of understanding of regulation 87202 and submit to CCL no later than 11/22/2024.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above as R1's resided in room #3 and is bedridden, but room #5 is the only room approved for bedridden, which posed an immediate health, safety or personal rights risk to resident in care.
8
9
10
11
12
13
14
Type B
11/22/2024
Section Cited
CCR87705(c)(5)

1
2
3
4
5
6
7
Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The licensee will review and write a statement of understanding of regulation 87705 and submit to CCL no later than 11/22/2024.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above as R1 was admitted with a diagnosis on dementia and had not had a new medical assessment or reappraisal conducted since moving in, which posed a potential health and personal rights risk to residents in care.
8
9
10
11
12
13
14
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: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


LIC809 (FAS) - (06/04)
Page: 2 of 2