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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200389
Report Date: 04/07/2022
Date Signed: 04/07/2022 03:50:23 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
11/24/2021 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20211124104754
FACILITY NAME:HILLCREST MEMORY CARE LIVINGFACILITY NUMBER:
079200389
ADMINISTRATOR:CECILY PALMAFACILITY TYPE:
740
ADDRESS:825 EAST 18TH STREETTELEPHONE:
(925) 706-7944
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:90CENSUS: 40DATE:
04/07/2022
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Donna Bautista Colmenares, Executive DirectorTIME COMPLETED:
03:17 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not meet residents needs timely
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/07/22 at 2:40PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a subsequent complaint visit and met with Executive Director (ED) to deliver the investigation finding. LPA explained the purpose of the visit with ED.

During investigation, LPA's review of resident's (R1) admission agreement showed R1 was first admitted at the facility on 11/19/21 under hospice care. Former Executive Director (ED) stated they assigned a one-on-one caregiver to R1 a week after admission because she was constantly calling the front desk demanding attention or would call 911 from her 2 cell phones. During visit, LPA observed the one-on-one caregiver assisting R1 with drinking water, adjusting her blanket and giving her cell phones. She told LPA that she is always there assisting R1 with her daily 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (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)
Page: 1 of 2
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
11/24/2021 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20211124104754

FACILITY NAME:HILLCREST MEMORY CARE LIVINGFACILITY NUMBER:
079200389
ADMINISTRATOR:CECILY PALMAFACILITY TYPE:
740
ADDRESS:825 EAST 18TH STREETTELEPHONE:
(925) 706-7944
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:90CENSUS: 40DATE:
04/07/2022
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Donna Bautista-Colmenares, Executive DirectorTIME COMPLETED:
03:17 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff took away resident's phone
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/07/22 at 2:40PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a subsequent complaint visit and met with Executive Director (ED) to deliver the investigation finding. LPA explained the purpose of the visit with ED.

During investigation, resident (R1) told LPA that staff did not take away her 2 cell phones. She told LPA that her cell phones ran out of battery power and could not use them. This department had investigated the complaint alleging that staff took away resident's phone. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (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)
Page: 2 of 2