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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330905299
Report Date: 01/05/2023
Date Signed: 01/05/2023 04:51:16 PM


Document Has Been Signed on 01/05/2023 04:51 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:CREST HOME FOR THE ELDERLYFACILITY NUMBER:
330905299
ADMINISTRATOR:RAMASAR, OSCARFACILITY TYPE:
740
ADDRESS:4460 CREST VIEW DRIVETELEPHONE:
(951) 736-2921
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:29CENSUS: 20DATE:
01/05/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Ghislaine Ramasar, licenseeTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced case management visit to the facility for a Health & Safety Check. LPA met with facility representatives Florence and Justin Nahim. Licensee arrived during today's visit.

LPA toured the facility. There are charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. LPA observed medications and sharps were kept locked and inaccessible to the clients. Outdoor and indoor passageways were kept free of obstruction. LPA observed a sufficient amount of food supplies. LPA observed all utilities in use.

During this visit, LPA did not observe imminent health & safety concerns.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to Mrs. Ramasar.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2023
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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