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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 052700992
Report Date: 05/07/2025
Date Signed: 05/29/2025 11:21:35 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
01/31/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250131132652
FACILITY NAME:FOOTHILL VILLAGE SENIOR LIVINGFACILITY NUMBER:
052700992
ADMINISTRATOR:JACOB HARRYMANFACILITY TYPE:
740
ADDRESS:1400 FOOTHILL VILLAGE DRIVETELEPHONE:
(805) 801-0404
CITY:ANGELS CAMPSTATE: CAZIP CODE:
95222
CAPACITY:78CENSUS: 50DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jacob Harryman TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Licensee does not ensure staff are in good health and capable of performing duties and assigned tasks
Staff do not ensure residents rooms are kept in clean sanitary conditions
Staff do not ensure facility is kept free of mal odors
Staff do not ensure residents are provided with clean linens
Licensee does not ensure residents personal belongings are kept safely secured
Staff do not ensure medications are dispensed as prescribed
INVESTIGATION FINDINGS:
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On 05/07/2025, Licensing Program Analysts (LPAs) Arielle Pascua and Triel Lindstrom arrived unannounced to this facility to conduct a complaint visit. LPAs met with Facility Designated Administrator (FDA), Jacob Harryman and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Current census was 50. A brief interview with FDA Harryman was conducted.
Allegation: Licensee does not ensure staff are in good health and capable of performing duties and assigned tasks
It was alleged that the licensee does not ensure staff are in good health and capable of performing duties and assigned tasks. During the course of this investigation, LPA reviewed facility files and conducted staff interviews. Based on interviews conducted with 7 staff members, 7 out 7 staff members state that they believe that they are in good health and are able to conduct their job duties as expected. 7 out 7 staff members deny that other staff members are unable to perform their job duties.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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 27-AS-20250131132652
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: FOOTHILL VILLAGE SENIOR LIVING
FACILITY NUMBER: 052700992
VISIT DATE: 05/07/2025
NARRATIVE
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A review of 7 staff records show that each staff member was given a health screening as well as a TB test. All records show that 7 out 7 staff members reviewed were provided clearance to work at the facility based on their health screening. In addition, LPA conducted observations and found no indication that the facility staff could not conduct their job duties. Based on the information gathered, there is not sufficient information that the licensee does not ensure that facility staff are in good health and capable of performing duties and assigned tasks.

Allegation: Staff do not ensure residents rooms are kept in clean sanitary conditions
It was alleged that facility staff do not ensure resident rooms are kept clean and sanitary conditions. During the course of this investigation, LPA conducted observations and conducted resident staff interviews. Based on interviews conducted with 7 staff members, 7 out 7 staff members deny that they do not ensure residents rooms are kept clean and sanitary. 7 out 7 staff members state that some residents can be messy but ensure to communicate this with management to ensure that their needs are being including keeping the resident rooms in a clean and sanitary manner. An interview with 7 residents were conducted. 7 out 7 residents state that the facility ensure that their rooms are kept tidy and clean. 7 out 7 resident deny that they do not get their rooms cleaned on a weekly basis. In addition, LPA conducted a tour of several resident bedrooms and found that all rooms were kept clean and sanitary. Based on the information gathered, there is not sufficient evident to prove that the staff do not ensure resident rooms are kept in clean and sanitary conditions.

Allegation: Staff do not ensure facility is kept free of mal odors
It was alleged that facility staff do not ensure facility is kept free of mal orders. During the course of this investigation, LPA conducted tours of the facility on 02/05/2025 and 05/07/2025 including but not limited to the main areas, dining area, living areas, resident bedrooms, and bathrooms. LPA was not able to smell any type of odors throughout the facility that was considered as malodorous. Based on the information gathered, there is not sufficient evidence to prove that the facility staff do not ensure facility is kept free of mal odors.

Allegation: Staff do not ensure residents are provided with clean linens
It was alleged that facility staff do not ensure that residents are provided with clean linens. During the course of this investigation, LPA conducted resident and staff interviews and conducted tours of resident bedrooms. Based on interviews with 7 staff members and 7 residents, 7 out 7 staff members deny that they do not provide residents with clean linens. It was stated that cleans are cleaned once a week as part of their admissions agreements or as needed through their care plan. 7 out 7 residents state that they are able to obtain clean linens if requested but prefer to have their own. LPA conducted a tour of several resident bedrooms and observed that all resident bedrooms had clean linens.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250131132652
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: FOOTHILL VILLAGE SENIOR LIVING
FACILITY NUMBER: 052700992
VISIT DATE: 05/07/2025
NARRATIVE
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Based on the information gathered, there is not sufficient evidence to prove that the facility does not ensure that residents have clean bed linens.

Allegation: Licensee does not ensure residents personal belongings are kept safely secured
It was alleged that the licensee does not ensure residents personal belongings are kept securely. During the course of this investigation, LPA reviewed facility records and conducted resident interviews. Based on interviews conducted, 7 out of 7 residents deny that their belongings are not kept safe. 4 out 7 residents have been living at this facility for up to 4 years and have no issues. 3 out 7 residents have lived at the facility for up to 1 year and report no issues regarding their personal belongings. A review of the facilities theft and policy was also conducted. This facility has a locked and secured space for the resident's belongings in resident rooms and may provide a lock for the dresser at the residents bedside as requested. Based on the information gathered, there is not sufficient evidence to prove that the facility does not ensure resident personal belongings are kept safely secured.

Allegation: Staff do not ensure medications are dispensed as prescribed
It was alleged that the staff do not ensure medication are dispensed as prescribed. During the course of this investigation, LPA reviewed facility records and conducted staff interviews. Based on interviews conducted 5 out 5 staff members deny that medications are not being provided as prescribed. It was stated by most residents obtain medication through a bubble pack system and are changed according to the doctor’s orders. An interview with 5 residents were attempted however, due to medication conditions, 2 out 2 residents did not know what medications were taken throughout the day. 3 out 5 residents reported no issues regarding their medication. A review of the Medication Administrator Record and compared to current medication. There was nothing to indicate that staff was not providing medication as prescribed. Based on the information gathered, there is not sufficient evidence to prove that the staff do not ensure medications are dispensed as prescribed.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3