CRESTAVILLA

Official classification

Type B

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by the Carbon monoxide alarm in R1’s room went off 53 times from November 6, 2025, to November 19, 2025, and the facility staff took no action. This poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee to train all staff on CCR 87465 and to submit proof of training to LPA. Licensee is to submit a written plan on how to ensure carbon monoxide notification is responded timely. Licensee to relocate pool heating pump vent to a safe location in compliance with applicable building codes. License to submit proof to LPA when completed.

Deadline recorded: Jun 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by, The facility failed to obtain the city permit prior to relocating and operating the pool and pool heater vent. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to obtain the proper city permit for the pool and pool heater vent. Licensee to submit proof of correction to LPA by POC due date.

Deadline recorded: Mar 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211(a)Each licensee shall furnish to the licensing agency ...(1)A written report shall be submitted to the licensing agency and to the person responsible within seven days... (D)Any incident which threatens the welfare, safety or health of any resident... This requirement is not met as evidenced by: The Licensee did not submit a written report for R1's incident that took place on August 3, 2025, to the responsible party and the Licensing Agency within seven days, which poses a potential health, safety and personal rights risk to residents.

Official plan of correction

Licensee agrees to train staff who submit incident reports to the Agency on CCR 87211 and to provide proof of training to LPA by POC due date.

Deadline recorded: Sep 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. LPA identified staff #8 (S8) did not have criminal record clearance transfer. Staff did not have an LIC 9162 on file nor transferred on CDSS Guardian. This violation which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/16/2024 Plan of Correction Licensee will ensure all staff have criminal clearance transfer prior to working at the facility. Staff #8 (S8) according to CDSS Guardian is not associated to this facility. Licensee will associate staff #8 (S8) by POC due date. Send proof of correction by email to ernand.dabuet@dss.ca.gov

Official classification

Type B

Official code

80075(f)

Regulation authority

CCR

What the official deficiency says

80075(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above. Staff #7 did not have First Aid/CPR certificate on file. This violation which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2024 Plan of Correction Licensee will ensure all facility staff must have the mandatory First Aid/CPR Training completed. As plan of correction, administrator will send proof of completed First Aid/CPR will be sent to LPA via email: ernand.dabuet@dss.ca.gov before POC due date.