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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850010
Report Date: 01/13/2023
Date Signed: 01/13/2023 08:00:13 PM


Document Has Been Signed on 01/13/2023 08:00 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:CRESTON VILLAGE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
405850010
ADMINISTRATOR:CHERYL MARSHFACILITY TYPE:
740
ADDRESS:1919 CRESTON ROADTELEPHONE:
(805) 239-1313
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:130CENSUS: 83DATE:
01/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Cheryl Marsh / AdministratorTIME COMPLETED:
12:50 PM
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 At 9:15am on 01/13/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to conduct the annual, infection control inspection. LPA was properly screened at the front entrance for COVID-19 protocols by front desk staff. LPA met with Administrator Cheryl Marsh and announced the reason for the visit.
Administrator and LPA conducted a cursory walk through tour of the facility. LPA observed a more than 30 day supply of PPE and more than 30 day supply of incontinence products for a facility of maximum capacity of 130 residents. LPA observed several bathrooms throughout the facility and bathrooms had liquid soap and paper towels available in the all observed bathrooms LPA observed at least two days of perishable and at least seven days of non-perishable foods on hand in the kitchen: food orders are normally delivered twice per week and local fresh products are purchased when needed. LPA confirmed that the last emergency fire inspection pressure test was conducted by Silicon Valley Incorporated on August of 2022. LPA observed fire extinguishers throughout the facility all in good working order with current inspection tags and pressure sensor in the green rating. LPA observed fire escape chairs at the top of each stairwell. LPA noted that no exits were blocked and all free and clear of obstructions and the facility appeared to be clean and in good repair. LPA noted that no violations or citations were issued as a result of the cursory walk through tour.
Administrator and LPA conducted the annual, infection control module of the annual inspection. LPA noted that no violations, technical, or citations were issued during the infection control module of this annual inspection. LPA noted that there were no observed violations or citations issued during this annual inspection, at this time.

Exit interview, report singed, and report emailed.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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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