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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880604
Report Date: 09/03/2025
Date Signed: 09/03/2025 12:29:33 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
08/02/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20250802215035
FACILITY NAME:CREST VILLAFACILITY NUMBER:
331880604
ADMINISTRATOR:RAMASAR, OSCARFACILITY TYPE:
740
ADDRESS:4014 CALIFORNIA AVETELEPHONE:
(951) 268-6040
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:15CENSUS: 13DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Administrators Ghislaine and Oscar RamasarTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility fire system is out of compliance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Administrators Ghislaine and Oscar Ramasar and explained the purpose of the visit. The investigation consisted of facility tour and staff interviews.

For the allegation, Facility fire system is out of compliance.

LPA observed Staff #2 (S2) on 08/08/2025 placing batteries into beeping smoke dectector. S1 stated fire department came to facility on 08/01/2025 and did not replace batteries due to not being able to find them. A previous licensing report was issued on 02/05/2025 giving notice of the same violation. Because you have been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. An immediate civil penalty of $250 is hereby assessed for the date of 09/03/2025.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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 5
Control Number 56-AS-20250802215035
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
VISIT DATE: 09/03/2025
NARRATIVE
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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.

During today’s visit, a deficiency and Civil Penalty was cited/issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099), LIC9099D, (LIC421FC) was discussed and provided to Administrator Ghislaine and Oscar Ramasar along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 56-AS-20250802215035
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: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2025
Section Cited
CCR
87303(a)
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Maintenance and Operation 87303
(a) The facility shall be clean, safe, sanitary and in good repair at all times...

This requirement is not met as evidenced by
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During visit on 08/08/2025 staff replaced smoke detector with batteries. Plan of Correction will be cleared.
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Based on observations, the licensee did not comply with the section cited above by not ensuring all smoke detectors were in working ability, which poses a potential health, safety or 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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
08/02/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20250802215035

FACILITY NAME:CREST VILLAFACILITY NUMBER:
331880604
ADMINISTRATOR:RAMASAR, OSCARFACILITY TYPE:
740
ADDRESS:4014 CALIFORNIA AVETELEPHONE:
(951) 268-6040
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:15CENSUS: 13DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Administrator Ghislaine RamasarTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility staff did not assess resident for a change in condition
Facility staff did not meet resident's hygiene needs
Facility staff are unable to provide emergency fire personnel information about the resident's medical condition
INVESTIGATION FINDINGS:
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For the allegation, Facility staff did not assess resident for a change in condition.

LPA conducted (2) staff interviews. 2 out of the 2 staff stated facility staff assess residents with change of conditions by providing PRN or in the event of emergency calling 911. Staff #2 (S2) stated they call emergency services in the event a resident may be in pain or requesting hospital services.

For the allegation, Facility staff did not meet resident's hygiene needs.

LPA observed facility shower schedule. LPA spoke with Administrator who stated residents will be asked to take a shower and some may decline. In the event of this, Administrator stated facility staff will motivate and ask residents every day to take a shower.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20250802215035
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
VISIT DATE: 09/03/2025
NARRATIVE
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For the allegation, Facility staff are unable to provide emergency fire personnel information about the resident's medical condition.

LPA conducted (2) staff interviews. 2 out of the 2 staff stated facility staff will provide emergency fire personnel with residents ID/Emergency contact sheet, medication log, and any allergies they may have. S2 stated when emergency personnel arrives they are provided with current medication log and resident information.

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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5