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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603360
Report Date: 05/17/2022
Date Signed: 05/17/2022 03:13:41 PM


Document Has Been Signed on 05/17/2022 03:13 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
RIVERSIDE, CA 92507



FACILITY NAME:CREST CAREFACILITY NUMBER:
374603360
ADMINISTRATOR:KATHERINE DOWDENFACILITY TYPE:
735
ADDRESS:3916 LIMBER PINE ROADTELEPHONE:
(760) 731-2220
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:4CENSUS: 4DATE:
05/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Licensee's Frank and Katherine DowdenTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control.

LPA was greeted and granted entry by Licensee Frank Dowden. LPA met with both Licensee's Frank and Katherine Dowden and explained the purpose of the visit. At the time of LPAs visit there were 2 staff and 3 client's present at the facility, with 1 client being at the day program. There are currently no cases of COVID-19 within the facility.

During today's visit, LPA George toured the facility and made observations pertaining to the facility's infection control measures that they have implemented. LPA George observed adequate hand hygiene supplies, sufficient cleaning and disinfecting provisions. The facility has an ample supply of paper goods such as paper towels and toilet paper. LPA observed staff wearing the proper face covering (surgical masks). LPA George discussed FIT testing, as it has not been completed. LPA provided the PIN 21-10-ASC that provides resources available for FIT testing.

The facility submitted their mitigation plan April 2021, the facility is following their mitigation plan, which also includes cleaning and disinfecting the highly touched surfaces multiple times throughout the day. The facility continues to monitor the client's for any changes in their condition which includes documented daily temperature checks.

An exit interview was conducted and a copy of this report was provided to Licensee's Frank and Katherine Dowden.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
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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