079200389-4-7-2022-15-AS-KHOS-CDLVJP-20220418162905

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200389
Report Date: 04/07/2022
Date Signed: 04/07/2022 03:45:11 PM

Unsubstantiated

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
03/30/2022 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20220330134319

FACILITY NAME:	HILLCREST MEMORY CARE LIVING		FACILITY NUMBER:	079200389
ADMINISTRATOR:	ELEINA RIDOLFI		FACILITY TYPE:	740
ADDRESS:	825 EAST 18TH STREET		TELEPHONE:	(925) 706-7944
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	90	CENSUS: 40	DATE:	04/07/2022
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Donna Bautista-Colmenares, Administrator Marina Peckham, Resident Care Coordinator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff does not meet residents grooming needs

INVESTIGATION FINDINGS:

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On 04/07/22 at 1:20PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced complaint visit, met with administrator (ADM) and resident care coordinator (RCC), gathered information and delivered complaint investigation finding. LPA explained the purpose of the visit with ADM and RCC during visit.

During investigation, LPA went on a tour of the facility inside and outside with RCC. LPA observed 6 female residents and 3 male residents lounging around the first floor common living areas relaxing on chairs & watching TV. LPA observed residents to be well groomed, wearing clean clothes & shoes. LPA observed residents did not have any offensive odors and were comfortable in their surroundings. LPA did not observe residents to be dishevelled or messy during prior visits on 12/13/21 and 03/01/22.

Continued on next page, LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20220330134319

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 LIVING	FACILITY NUMBER: 079200389
	VISIT DATE: 04/07/2022

NARRATIVE

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LPA observed an in house beauty salon located on the second floor. RCC stated this is the place where residents can go to have their hair done or cut by a professional hair stylist. RCC stated they also have an in-house podiatrist that comes to the facility to service residents' foot needs.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated.

No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC9099 (FAS) - (06/04)

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