565801541-11-8-2022-29-AS-JAPL-CMZ3CN-20230111170809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801541
Report Date: 11/08/2022
Date Signed: 11/08/2022 03:30:40 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2022 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20221107150416

FACILITY NAME:	FINEST LIVING AT CRESTWOOD		FACILITY NUMBER:	565801541
ADMINISTRATOR:	ADELAIDA G. CRUZ		FACILITY TYPE:	740
ADDRESS:	225 CRESTWOOD AVENUE		TELEPHONE:	(805) 212-8303
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	6	CENSUS: 6	DATE:	11/08/2022
		UNANNOUNCED	TIME BEGAN:	11:46 AM
MET WITH:	Adelaida Cruz		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Licensee failed to keep the facility free of rodents and/or insects.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted an initial complaint visit to the above facility. LPA met with staff member at 11:46 a.m. Administrator Adelaida Cruz arrived at the facility at 12:50 p.m. Entrance interview conducted.

On 11/07/2022, the Department received a complaint regarding licensee failed to keep the facility free of rodents and/or insects. On 11/08/2022, LPA Ascencio conducted a facility tour starting at 11:48 a.m. At 11:50 a.m., the activity area/medication cabinet was observed to have rodent droppings by a corner outlet plug. At 11:57 a.m., LPA observed the attic which contained a mouse trap with multiple roden droppings surrounding the area. Staff #1 (S1) stated that they had a rat problem a few weeks back. The rats were observed to wander about the kitchen and the hallways. Pest control has been out to the home and placed traps everywhere. At 12:17 p.m., Resident #1 (R1) room was observed to have rat droppings underneath a red sofa chair. LPA asked staff to move the chair.
Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

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 4

Control Number 29-AS-20221107150416

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FINEST LIVING AT CRESTWOOD	FACILITY NUMBER: 565801541
	VISIT DATE: 11/08/2022

NARRATIVE

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Additional droppings were observed under the chair. Admin spoke to LPA at 1:10 p.m. and stated pest control came out in September 2022. Pest control advised us that there are entry points in the house the rats are coming in. Staff have since fenced off those entry points. Admin added that there is no more rat problem. LPA Ascencio stated that LPA observed rat dropping throughout the facility. If the facility did not have anymore rats, there should not have been any rat droppings observed. Admin stated the rat droppings were not removed accordingly. Based on interviews and observation, the allegation Licensee failed to keep the facility free of rodents and/or insects is deemed substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited
(refer to LIC 9099-D):

Exit interview conducted, today's reports, civil penalty and appeal rights were reviewed and emailed to the
Administrator.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20221107150416

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FINEST LIVING AT CRESTWOOD	FACILITY NUMBER: 565801541
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/18/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Admin will conduct a deep-clean of the faciity. Admin will contract pest control company to inspect the home. Admin will submit proof of pest control by 11/18/22.
	8 9 10 11 12 13 14	Based on interviews and observation, the licensee did not comply with the section cited above as rat droppings were observed throughout the facility which poses a potential health, safety and personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC9099 (FAS) - (06/04)

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