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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 052700992
Report Date: 11/05/2021
Date Signed: 11/05/2021 01:55:03 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/02/2021 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 27-AS-20211102084427
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: 54DATE:
11/05/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Hope BitlerTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is not serving food of the quality to meet the needs of the residents in care.
Facility is not communicating with residents, residents' responsible parties and staff regarding COVID-positive cases.
Staff are not screening visitors for COVID-19 symptoms prior to entering facility.
INVESTIGATION FINDINGS:
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Licensing Program Anlayst (LPA) Sarah Hurt arrived at the facility unnanounced to conduct an investigation on the above allegations. LPA met with Facility Administrator Hope Bilter and explained the purpose for today's visit. LPA collected documents, and interviewed several staff.

Regarding the allegation that facility is not serving food of the quality to meet the needs of the residents in care. Based on LPA's interviews with several staff members, LPA observation of staff preparing food, and reviewing facility weekly food menu. The facility is feeding residents food of the quality that meets residents needs. Therefore, the allegation is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Continued on 9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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 2
Control Number 27-AS-20211102084427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: FOOTHILL VILLAGE SENIOR LIVING
FACILITY NUMBER: 052700992
VISIT DATE: 11/05/2021
NARRATIVE
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Continued from 9099..

Regarding the allegation the facility is not communicating with residents, residents' responsible parties and staff regarding COVID-positive cases. This investigation is based on LPA's interviews with several staff members, and records reviewed. LPA observed several letters given to staff, and residents informing them of the COVID 19 cases in the building. Several facility staff stated they are personally contacting residents responsible parties regarding the COVID positive cases at the facility, and continue to be in contact with them on a daily basis. Therefore, the allegation is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.


Regarding the allegation staff are not screening visitors for COVID-19 symptoms prior to entering facility. Based on LPA's observation of staff screening herself and others entering the facility. LPA also reviewed sign in sheets dated several months back to current with different visitors information and COVID- 19 screening questions. The facility staff is screening visitors for COVID- 19 symptoms prior to entering the facility. Therefore, the allegation is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.


Based on today's visit, per California code of Regulations, Title 22 Division 6, Chapter 8 no deficiencies were observed or cited today.


An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2