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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880604
Report Date: 04/21/2026
Date Signed: 05/15/2026 02:19:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20251125220805
FACILITY NAME:CREST VILLAFACILITY NUMBER:
331880604
ADMINISTRATOR:GHISLAINE RAMASARFACILITY TYPE:
740
ADDRESS:4014 CALIFORNIA AVETELEPHONE:
(951) 268-6040
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:15CENSUS: 14DATE:
04/21/2026
UNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Ghislaine RamasarTIME COMPLETED:
03:44 PM
ALLEGATION(S):
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Staff did not seek medical care for resident in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings for the allegations above. LPA met with Staff Nestor Frijas and explained the purpose of the visit. The investigation consisted of facility tour and staff interviews

On 11/25/2025, the department received a complaint regarding staff not seeking medical care for resident in a timely manner. Interviews revealed that Staff #1 noticed Resident #1 (R1) face to be swollen Sunday night on 11/23/2025 but did not take R1 to the hospital or call emergency services. R1 was then taken to hospital next morning as swelling began to worsen.

Based on the evidence gathered during today’s investigation, the allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met. An exit interview was conducted and a copy of this report (LIC9099) and (LIC9099A) was discussed and provided to Administrator Ghislaine Ramasar along with copy of appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
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 56-AS-20251125220805
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 VILLA
FACILITY NUMBER: 331880604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2026
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following: (2) to be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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Licensee stated to complete an in-service training for facility staff and send to LPA by Plan of Correction (POC) due date.
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Based on record review and interviews, the licensee did not comply with sectioned cited above by not ensuring Resident #1 (R1) was accorded safe and healthful by not providing care to R1 in a timely manner, which poses a potential health, safety, and personal rights risk to persons 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.
SUPERVISOR'S NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20251125220805

FACILITY NAME:CREST VILLAFACILITY NUMBER:
331880604
ADMINISTRATOR:GHISLAINE RAMASARFACILITY TYPE:
740
ADDRESS:4014 CALIFORNIA AVETELEPHONE:
(951) 268-6040
CITY:NORCOSTATE:CAZIP CODE:
92860
CAPACITY:15CENSUS: 14DATE:
04/21/2026
UNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Administrator Ghislaine RamasarTIME COMPLETED:
03:44 PM
ALLEGATION(S):
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Staff did not address flies in the facility
INVESTIGATION FINDINGS:
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On 11/15/2025, an additional allegation was alleged regarding not addressing flies in the facility. LPA observed facility do have pest control come monthly. During LPAs visit, no flies were observed.

Based on the evidence gathered during today’s investigation, the allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and this report (LIC9099A) along with other reports were discussed and provided to Administrators Ghislaine and Oscar Ramasar.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3