455002932-12-2-2024-59-AS-KHOS-DBSME3-20241209083205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002932
Report Date: 12/02/2024
Date Signed: 12/02/2024 02:04:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2024 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 59-AS-20241003084921

FACILITY NAME:	HILLTOP SPRINGS SENIOR LIVING		FACILITY NUMBER:	455002932
ADMINISTRATOR:	O'FARRELL, KEILA		FACILITY TYPE:	740
ADDRESS:	7 HILLTOP DR		TELEPHONE:	(530) 395-1777
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	211	CENSUS: 168	DATE:	12/02/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator, Keila O'Farrell		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff caused injuries to resident in care.
Staff did not ensure resident was fed.
Staff mismanaged resident's medications.
Staff did not answer resident's call button in a timely manner.
Staff did not ensure resident's room was cleaned and sanitized.
Staff are not properly trained to transfer residents.
Staff did not report incidents to resident's responsible party.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On December 02, 2024 at approximately 09:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Hilltop Springs Senior Living for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Administrator, Keila O'Farrell and was granted access into the facility.

During the course of the investigation, LPA reviewed facility records, resident records, interviewed staff, witnesses and a collateral interview with Resident #1.

Complaint alleges that Staff caused injuries to resident in care and Staff did not report incidents to resident's responsible party. Based on an observation of facility records, resident records and interviews that were conducted with 4 witnesses which included two doctors and two home health nurses, LPA received inconsistent statements. (Report continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

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 59-AS-20241003084921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HILLTOP SPRINGS SENIOR LIVING	FACILITY NUMBER: 455002932
	VISIT DATE: 12/02/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During an interview with Resident #1, LPA learned that during one incident, staff was assisting the resident out of bed when the resident slipped and fell on the guardrails. During this incident, Resident #1 could not identify the date, time and/or the staff members involved with the assistance. A review of an incident report dated for September 17, 2024, reflected that the resident fell and that the Responsible Party was notified of this fall. In addition, LPA reviewed an additional incident report dated for September 20, 2024, which reflected the residents change of condition. Furthermore, LPA could not corroborate the allegations.

Complaint alleges that Staff did not ensure resident was fed. Based on observation of facility records, resident records and interviews that were conducted, LPA received inconsistent statements. Furthermore, during an interview with Resident #1, LPA learned that the resident would eat three times a day and would order food, and that staff would drop it off in the room. During a review of the Progress Notes on October 24, 2024, LPA observed in the notes that the resident had to be reminded to eat food. Furthermore, LPA could not corroborate the allegation.

Complaint alleges that Staff mismanaged resident's medications. Based on observation of facility records, resident records and interviews that were conducted, LPA received inconsistent statements. Furthermore, during a collateral interview with Resident #1, LPA received inconsistent statements as it relates to the amount that was given. During the opening of the complaint on October 4, 2024, LPA reviewed the Medication Administration Record (MAR) and the Medication Order for the medication in question, LPA did not observe any discrepancies. Furthermore, LPA could not corroborate the allegation.

Complaint alleges that Staff did not answer resident's call button in a timely manner. Based on observation of facility records and interviews that were conducted, LPA received inconsistent statements. Furthermore, during a review of the call button history, LPA observed no calls exceeding one hour as initially reported. LPA could not corroborate the allegation.

Complaint alleges that Staff did not ensure resident's room was cleaned and sanitized. Based on observation of facility records and interviews that were conducted, LPA received inconsistent statements. Furthermore, during a collateral interview with Resident #1, Resident reported that the staff members cleaned the room. LPA could not corroborate the allegation.

(Report continued on LIC 9099C

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 59-AS-20241003084921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HILLTOP SPRINGS SENIOR LIVING	FACILITY NUMBER: 455002932
	VISIT DATE: 12/02/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Complaint alleges that Staff are not properly trained to transfer residents. Based on observation of facility records, LPA received inconsistent statements. Furthermore, during a review of staff training records on December 02, 2024, LPA observed sufficient training hours as outlined in Title 22 Regulations. LPA could not corroborate the allegation.

A finding that the complaint allegations of Staff caused injuries to resident in care, Staff did not ensure resident was fed, Staff mismanaged resident's medications, Staff did not answer resident's call button in a timely manner, Staff did not ensure resident's room was cleaned and sanitized, Staff are not properly trained to transfer residents and Staff did not report incidents to resident's responsible party are unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and given to the Administrator.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3