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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006198
Report Date: 10/01/2025
Date Signed: 10/01/2025 01:05:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250923163448
FACILITY NAME:CRESTAVILLAFACILITY NUMBER:
306006198
ADMINISTRATOR:MYRA ARAGONESFACILITY TYPE:
740
ADDRESS:30111 NIGUEL RDTELEPHONE:
(949) 844-5997
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:250CENSUS: 213DATE:
10/01/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Myra AragonesTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not ensure food served to residents was free from contamination.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Executive Director Myra Aragones and explained the reason for the visit. LPA and the Executive Director toured the facility including the kitchen. The investigation revealed the following. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA inspected the perishable food supply. LPA inspected the 7 day non-perishable food supply. No deficiencies observed in the food supply. LPA observed the facility serving lunch during the visit. LPA interviewed 5 staff members. 5 out of 5 staff members interviewed reported they had not observed any contaminates or foreign objects in any of the food served to residents. LPA interviewed 7 residents. 6 out of 7 residents reported they had no issues with the food and have never had any contaminants or foreign objects in the food. 1 out of 7 residents reported that one time they were served food that had worms in it. LPA did not observe any foreign objects or contaminants during the lunch service.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
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 2
Control Number 22-AS-20250923163448
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CRESTAVILLA
FACILITY NUMBER: 306006198
VISIT DATE: 10/01/2025
NARRATIVE
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LPA did not observe any insects, rodents or worms anywhere in the facility. Based on the evidence gathered the allegation is deemed unsubstantiated, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2