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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 052700992
Report Date: 08/17/2023
Date Signed: 08/17/2023 01:54:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2023 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20230811091254
FACILITY NAME:FOOTHILL VILLAGE SENIOR LIVINGFACILITY NUMBER:
052700992
ADMINISTRATOR:BITLER, MAUREEN H.FACILITY TYPE:
740
ADDRESS:1400 FOOTHILL VILLAGE DRIVETELEPHONE:
(805) 801-0404
CITY:ANGELS CAMPSTATE: CAZIP CODE:
95222
CAPACITY:78CENSUS: 69DATE:
08/17/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Mary Mc Clure TIME COMPLETED:
11:40 PM
ALLEGATION(S):
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Staff serves expired food to the residents.
INVESTIGATION FINDINGS:
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On 08/17/2023, Licensing Program Analyst (LPA) Kimberly Viarella, and Licensing Program Manager (LPM), Liza King made an unannounced 10-day complaint visit to open an investigation. The LPA identified herself and the purpose of the visit and asked to speak to the Designated Facility Representative. The LPA met with Mary McClure and a brief interview followed.
Based on observations made during a tour of the facilty, interviews, and a record review, the allegation, "Staff serves expired food to the residents," was found to be SUBSTANTIATED. Expired food was observed during this inspection. Examples included heavy cream with an expiration date of 8/16/23, macaroni salad that expired on 7/27/23, yogurt that expired on 7/7/23, chicken boullion with an expiration date of 10/15/22, and chicken noodle soup that expired on 4/27/23. The perponderance of evidence has been met. As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
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 5
Control Number 27-AS-20230811091254
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: FOOTHILL VILLAGE SENIOR LIVING
FACILITY NUMBER: 052700992
VISIT DATE: 08/17/2023
NARRATIVE
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The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

A copy of the Appeal Rights were printed, with a copy, left with the facility designated Administrator after discussing them with this LPA at this time.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20230811091254
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: FOOTHILL VILLAGE SENIOR LIVING
FACILITY NUMBER: 052700992
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2023
Section Cited
CCR
87555(a)
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(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of... All food shall be selected, stored, prepared and served in a safe and healthful manner.

This requirement is not met as evidenced by:
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The Licensee shall create a cleaning schedule that will ensure the refrigerator, freezers, and pantry areas are all inspected and that expired foods are disposed of and all foods are labeld and packaged per regulations. This plan will be submitted to kimberly.viarella@dss.ca.gov by 08/24/2023.
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Based on an inspection of the refrigerator and pantry area 19 out of 25 food items were expired.
The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
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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: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2023 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20230811091254

FACILITY NAME:FOOTHILL VILLAGE SENIOR LIVINGFACILITY NUMBER:
052700992
ADMINISTRATOR:BITLER, MAUREEN H.FACILITY TYPE:
740
ADDRESS:1400 FOOTHILL VILLAGE DRIVETELEPHONE:
(805) 801-0404
CITY:ANGELS CAMPSTATE: CAZIP CODE:
95222
CAPACITY:78CENSUS: 69DATE:
08/17/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Mary Mc Clure TIME COMPLETED:
11:40 PM
ALLEGATION(S):
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Staff does not ensure that facility provides a safe environment for the residents.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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Based on observations made during a tour of the facility, interviews, and a record review, the allegation, "Staff does not ensure that facility provides a safe environment for residents," was determined to be UNFOUNDED. A result of UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Elevator permits were in compliance and did not expire until 03/27/2024. This LPA learned that expired copies were on display in each elevator due to the fact that a specific type of wrench was required to open the display case for each. The new permits have been posted and were also available on file in both the Business and Maintenance Director's offices. In addition, LPAs inspected the fire extinguishers and found to be in compliance with the last inspection dated 01/16/2023 by Silicon Valley Inc. The Executive Director does an additional monthly inspection (not required by the California Code of Regulations) and they too were up to date.


Unfounded
Estimated Days of Completion: 0
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20230811091254
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: FOOTHILL VILLAGE SENIOR LIVING
FACILITY NUMBER: 052700992
VISIT DATE: 08/17/2023
NARRATIVE
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Based on observations made during a tour of the facility, interviews, and a record review, the allegation, "Facility is in disrepair," was also determined UNFOUNDED. LPM observed sections of missing ceiling tiles on the third floor riser. During the course of this investigation the LPA learned that these sections were missing because the fire inspector required access to the 2 valves and a box located in that section of the ceiling. These sections were only as large as needed per the fire inspector's request. No deficiencies were observed cited.

During the facility tour today the LPM noticed a teaspoonful of coffee grounds on the floor near a trash chute. Residents take their own trash out to these trash chutes. Coffee grounds were either stuck to a trash bag or fell out of a trash bag while it was being stuffed into the chute. This too was not a repair issue. No deficiencies were observed cited.

Exit interview.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5