330905299-11-6-2024-56-AS-RHEZ-DAS3QJ-20241106172712

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 330905299
Report Date: 11/06/2024
Date Signed: 11/06/2024 05:27:29 PM

Document Has Been Signed on 11/06/2024 05:27 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	CREST HOME FOR THE ELDERLY		FACILITY NUMBER:	330905299
ADMINISTRATOR/ DIRECTOR:	RAMASAR, OSCAR		FACILITY TYPE:	740
ADDRESS:	4460 CREST VIEW DRIVE		TELEPHONE:	(951) 736-2921
CITY:	NORCO	STATE: CA	ZIP CODE:	92860
CAPACITY: 29	TOTAL ENROLLED CHILDREN: 0	CENSUS: 28	DATE:	11/06/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:17 PM
MET WITH:	Administrator Oscar & Ghislane Ramasar		TIME VISIT/ INSPECTION COMPLETED:	05:35 PM

NARRATIVE

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Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrators Oscar & Ghislane Ramasar and was granted entry to the facility. Licensed capacity is (29) current census (28). LPA was accompanied by Administrator Oscar and Ghislane Ramasar to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated office for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care.

Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week.

Record Review: LPA reviewed (6) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA reviewed (6) resident medications.

**Continuation on LIC809C**

Efren Malagon	TELEPHONE: (951) 202-6356
Raquel Hernandez	TELEPHONE: 951-248-0336
	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CREST HOME FOR THE ELDERLY	FACILITY NUMBER: 330905299
	VISIT DATE: 11/06/2024

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LPA observed Resident #1 (R1), Resident #2 (R2), Resident#3 (R3), Resident #4 (R4) medications were transferred from original received medication packet to a separate container. Deficiency will be issued.

Additionally, LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. No issues were observed.

Based on the observations made during today’s visit, a deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) and (LIC809D) was discussed and provided to Administrator Oscar & Ghislane Ramasar.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Raquel Hernandez	TELEPHONE: 951-248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/06/2024 05:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CREST HOME FOR THE ELDERLY	FACILITY NUMBER: 330905299
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Incidental Medical and Dental Care Services

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review the licensee did not comply with the section cited above by not ensuring Resident #1 (R1), Resident #2 (R2), Resident#3 (R3), Resident #4 (R4) medications were stored in it's orginal received container, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/07/2024
	Plan of Correction
1 2 3 4	Licensee stated to submit photo documentation of all resident's medications stored properly in the orginal received container/packet by Plan of Correction (POC) due date.

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.

Efren Malagon	TELEPHONE: (951) 202-6356
Raquel Hernandez	TELEPHONE: 951-248-0336
	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC809 (FAS) - (06/04)

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