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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201249
Report Date: 11/19/2025
Date Signed: 11/19/2025 02:45:08 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2024 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20240807122234
FACILITY NAME:HILLCREST MEMORY CAREFACILITY NUMBER:
079201249
ADMINISTRATOR:FOZ, ROMERICOFACILITY TYPE:
740
ADDRESS:825 E 18TH STREETTELEPHONE:
(925) 706-7944
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:90CENSUS: 80DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Jared Pickard, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff neglect resulted in resident hospitalization
INVESTIGATION FINDINGS:
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On 11/19/25 at 2PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver the finding of above allegation. LPA explained the purpose of the visit with ADM.

During investigation, the Department obtained the following documents from administrator – personnel record, residents’ roster, admission agreement, physicians report, Needs & services plans, centrally stored medication logs, hospital discharge summary reports, incident reports

Continued on next page, LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 3
Control Number 15-AS-20240807122234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: HILLCREST MEMORY CARE
FACILITY NUMBER: 079201249
VISIT DATE: 11/19/2025
NARRATIVE
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Allegation: Staff neglect resulted in resident hospitalization
Investigation Finding: Substantiated
During investigation, the Department reviewed resident’s (R1) medical records which showed R1 was admitted to the hospital twice (08/02/24 and 08/06/24) in one week due to heat exposure. On 08/02/24 at approximately 1800 hours, R1 was found outside the facility lying on concrete for an unknown period of time. It was noted that it was nearly 100 degrees Fahrenheit that day. 911 was called and emergency Medical Services (EMS) recorded R1’s body temperature at 107degrees Fahrenheit. R1 was transported to the hospital where he was admitted and diagnosed with heat exposure. On 08/06/24 at approximately 1630 hours, R1 was found by staff outside the facility on his wheelchair unresponsive. 911 was called and staff administered Cardiopulmonary resuscitation (CPR) until EMS personnel arrived. R1 had a weak pulse with his body hot to the touch. It was noted that it was also very hot outside that day with temperatures close to 100 degrees Fahrenheit. Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff neglect resulted in resident hospitalization was found to be substantiated.

On 7/30/25 S1 was interviewed and reported that on 8/2/24 S1 noticed from the medication room monitor that R1 was lying down outside of the patio area and believed that he had been on the ground for 45 minutes. S1 further stated that R1 was hot to the touch and that S1 had called for assistance but none responded to the calls and that other staff remained “sitting around.” S1 also reported that on 8/6/25 that R1 was found by non-caregiver staff outside in R1’s wheelchair. S1 came out to check R1 and found R1 to be unresponsive and not breathing. S1 stated that care staff neglected R1 because he had previously been hospitalized for being left outside.

Immediate civil penalty of $500 assessed during visit.

Additional civil penalty determination is pending relating to this complaint.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and copy of report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20240807122234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: HILLCREST MEMORY CARE
FACILITY NUMBER: 079201249
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2025
Section Cited
CCR
87468.2(a)(4)
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Residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs…
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Immediate civil penalty of $500 assessed during visit.

Non compliance meeting (NCC) will be scheduled.

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This requirement was not met as evidenced by R1 being left outside unattended during hot weather for extended amounts of time, resulting in R1 twice requiring hospitalization, which poses an immediate health & safety risk to residents in care.
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By POC due date, Administrator agreed to complete and submit in-service staff training on proper care and supervision of residents in compliance with Title 22 Section 87468.2 (a)(4)
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
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