CREST VILLA

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following: (2) to be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Based on record review and interviews, the licensee did not comply with sectioned cited above by not ensuring Resident #1 (R1) was accorded safe and healthful by not providing care to R1 in a timely manner, which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee stated to complete an in-service training for facility staff and send to LPA by Plan of Correction (POC) due date.

Deadline recorded: May 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. 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 by not ensuring medication for Resident #2 (R2) was documented and maintained on Medication Administration Record (MAR),which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2026 Plan of Correction Licensee stated to go over medication documentation with all staff and contact pharmacy in regards to updated MAR. In-service training will also be done and sent to LPA. Plan of Correction (POC) will be cleared.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 by not ensuring an updated reappraisal for Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #5 (R5), and Resident #7 (R7) was completed,which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2026 Plan of Correction Licensee stated to submit to LPA updated reappraisals for R1, R2, R3, R5, and R7 by Plan of Corretion (POC) due date.

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 by not ensuring an updated needs and services plan for R1, R2, R5 was completed, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2026 Plan of Correction Licensee stated to submit updated needs and services plan for R1, R2, and R5 to LPA by POC due date.

Official classification

Type B

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care....(h) The following requirements shall apply to medications which are centrally stored:.... (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidence by: Based on interviews, record review the licensee did not follow " Incidental Medical and Dental Care " resulting on Resident #1 to have controlled substance on their possesion, which poses an immediate Health, Safety, or Personal Rights risk to residents in care.

Official plan of correction

The Licensee has agreed to read over: Incidental Medical and Dental Care regulation and provide training to all staff managing medication. And discuss the importance of keeping medication locked and secured, and following the proper measures to ensure medication is being taken by the resident. Proof of training will be emailed to LPA by POC 4/10/2026.

Deadline recorded: Apr 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General....(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidence by: Based on interviews, record review the licensee did not follow " Personnel Requirements " to Resident #1 to observe residents change of condition, which poses an immediate Health, Safety, or Personal Rights risk to residents in care.

Official plan of correction

The Licensee has agreed to read over: Personnel Requirements - General regulation and provide training to all staff regarding observation and properly responding to residents change of conditions. Proof of training will be emailed to LPA by POC 4/10/2026.

Deadline recorded: Apr 10, 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 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency... (1) A written report shall be submitted to licensing agency... (D) Any incident which threatens the welfare, safety or health of any resident... Based on record review, the licensee did not comply with section cited above by not ensuring a written report was submitted to licensing for incident regarding Resident #1 (R1) within seven days of occurence, which poses a potential health, saftey or personal rights risk to persons in care.

Official plan of correction

Licensee stated to read over regulation 87411 Reporting Requirements with facility staff to ensure compliance. POC will be cleared.

Deadline recorded: Dec 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 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.

Official plan of correction

During visit on 08/08/2025 staff replaced smoke detector with batteries. Plan of Correction will be cleared.

Deadline recorded: Sep 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.31(e)

Regulation authority

HSC

What the official deficiency says

1569.31 Basic Services Requirement (e)Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. Based on interviews, licensee failed to meet this requirement by not ensuring staff were properly supervising residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated to submit proof of staff training on supervision rules to LPA Hernandez by Plan of Correction (POC) due date.

Deadline recorded: Apr 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not ensuring bleach, cleaning solutions, scissors and a hammer were locked inacessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/10/2025 Plan of Correction Licensee removed cleaning solutions and sharps during LPA Hernandez visit.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. 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 by not ensuring Resident #1 (R1) Medication Administration Record (MAR) was documented correctly, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/10/2025 Plan of Correction Licensee stated to submit staff training on MAR documentation to LPA Hernandez by Plan of Correction (POC) due date.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or the services he needs. 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 by not ensuring Resident #4 (R4), Resident #5 (R5), Resident #6 (R6) and Resident #7 (R7) have a completed Needs and Services plan, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Licensee stated to submit Needs and Services Plans for residents stated above to LPA Hernandez by Plan of Correction (POC) due date.

Official classification

Type B

Official code

87506(b)(17)(A)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (A) Section 87457, Pre-Admission Appraisal; This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not ensuring Resident #1 (R1), Resident #2 (R2), Resident #3 (R3) and Resident #5 (R5) to have a Pre-Placement Apprasial completed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Licensee stated to submit Pre-Placement Apprasials for residents stated above to LPA Hernandez by POC due date.

Official classification

Type B

Official code

87506(b)(17)(B)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (B) Section 87459, Functional Capabilities; 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 by not ensuring Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #5 (R5), Resident #6 (R6) and Resident #7 (R7) do not have a Functional Capabilities Assessment. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Licensee stated to submit Functional Capabilities Assessments for residents stated up above to LPA Hernandez by Plan of Correction (POC) due date.

Official classification

Type B

Official code

87506(b)(17)(E)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (E) Section 87463, Reappraisals; and This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record reivew the licensee did not comply with the section cited above by not ensuring Resident #1 (R1) has a completed Reapprasial form.which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Licensee stated to submit Reapprasial form for R1 to LPA Hernandez by POC due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. 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 by not ensuring Resident #1 (R1) has an updated Physician Report, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Licensee stated to submit update physician report to LPA Hernandez by Plan of Correction (POC) due date.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement is not met as evidenced by: Deficient Practice Statement Based observation and record review, the licensee did not compy with the section cited above by not ensuring Resident #5 (R5) has a completed and signed Admission Agreement, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Licensee stated to submit Admission Agreement for R5 to LPA Hernandez by POC due date.

Official classification

Type B

Official code

87211(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (1) A written report shall be submitted to the licensing agency..seven days of the occurrence of any of the events specified..(D)..unexplained absence of any resident. Based on record review, licensee failed to meet this requirement by not ensuring disapperance of resident was reported to licensing agency within seven days of occurence, which poses a potential health, saftey or personal rights risk to persons in care.

Official plan of correction

Licensee stated to submit written report of all occurences within seven day such as those stated within regulation to licensing department.

Deadline recorded: Apr 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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: Based on observations, the facility administrators did not comply with the section cited above by not ensuring all smoke alarms were in working ability. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated to ensure all smoke alarms are hard wired and batteries are replaced to ensure alarms are in working ability and submit photo documentation to LPA Hernandez by Plan of Correction (POC) due date.

Deadline recorded: Feb 12, 2025. A deadline is not proof that correction was completed.