079200389-12-27-2022-15-AS-YFLS-CMLTB8-20221230133441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200389
Report Date: 12/27/2022
Date Signed: 12/27/2022 03:54:37 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
05/18/2020 and conducted by Evaluator Lisha Holmes

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20200518161350

FACILITY NAME:	HILLCREST MEMORY CARE LIVING		FACILITY NUMBER:	079200389
ADMINISTRATOR:	SONJA JOHNSON		FACILITY TYPE:	740
ADDRESS:	825 EAST 18TH STREET		TELEPHONE:	(925) 706-7944
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	90	CENSUS: 38	DATE:	12/27/2022
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Marina Peckham, Resident Care Director		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff mishandling residents' medication
Staff are not properly trained
Staff did not refill residents' medications in a timely manner
Staff leave residents unattended
Staff failed to meet residents' needs

INVESTIGATION FINDINGS:

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On 12/27/2022 at 12:05 PM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced complaint visit and met with Marina Peckham, Resident Care Director and explained the purpose for the visit.

LPA requested a Resident roster, Staff roster, toured the facility, including but not limited to the medication room, interviewed Staff and Residents. LPA interviewed five (5) Residents, four (4) Staff and discussed the administrative and operational changes from the year 2020 to 2022. Staff #5 (S5) and Staff #6 (S6) are the only staff that were employed since 2020 and both confirmed that there was a different Electronic Medication Administration Records system (EMAR) during 2020 was also more user friendly. Both systems had the ability to print individual residents' medication records. S5 and S6 received training through Care and Compliance along with Relias while employed, both were observed caring and meeting residents' needs, all residents were well groomed and facility was clean and in order. The prior ED was on maternity leave during the complaint allegations and did not confirm the allegations. S1 did not confirm the above allegations when interviewed.
...continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022

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-20200518161350

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: 12/27/2022

NARRATIVE

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...continued from LIC9099

S2 was terminated stating that some staff did not do their jobs, S3 stated that some residents were left unattended along with S4 stating that the laundry and showering of residents were needed as well. Interviews with five (5) Witnesses could not confirm or deny all of the above allegations. Interviews with Residents (R1, R2, R3, R4 and R5) deny all of the above allegations.

Allegations:
Staff mishandling residents' medication: LPA could not confirm or deny the allegations.
Staff are not properly trained: All staff received Direct Care and Orientation Training through Relias, Care and Compliance, and proof of first aid certification was current.
Staff did not refill residents' medications in a timely manner: Although the facility medications records were possibly recorded incorrectly, records revealed refills present on the Centrally Stored Medication and Destruction Records and Order Summary Reports.
Staff leave residents unattended: Interviews could not confirm that residents were left unattended. The facility’s AM, PM and Housekeeping schedules indicated sufficient staff.
Staff failed to meet residents' needs: Facility regularly submitted incident reports during the year of 2020.
The preponderance of evidence has not been met; therefore, the above allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of this report provided to Marina Peckham.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022

LIC9099 (FAS) - (06/04)

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