079200389-10-12-2021-15-AS-YFLS-C7SVAF-20211014161551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200389
Report Date: 10/12/2021
Date Signed: 10/12/2021 03:32:05 PM

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
11/07/2019 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20191107111509

FACILITY NAME:	HILLCREST MEMORY CARE LIVING		FACILITY NUMBER:	079200389
ADMINISTRATOR:	CECILY PALMA		FACILITY TYPE:	740
ADDRESS:	825 EAST 18TH STREET		TELEPHONE:	(925) 706-7944
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	90	CENSUS: 51	DATE:	10/12/2021
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Cecily Palma		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff failed to notify family members about scabies outbreak in the facility
Facility failed to implement measures to address scabies outbreak

INVESTIGATION FINDINGS:

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On 10/12/2021, Licensing Program Analyst (LPA) L.Ibo arrived at the facility to deliver findings on the above allegations. LPA met with Cecily Palma, Executive Director.

On November 7, 2019, LPA Praveen Singh initiated the 10-day investigation, conducted interviews and obtained information related to the allegations.

On September 24, 2021, LPA Luisa Fontanilla obtained Lic 500, Nurse Practitioner and hospice notes for 3 out of 4 residents identified in the complaint. Executive Director was not able to provide document for one resident to LPA.

...continued to LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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-20191107111509

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: 10/12/2021

NARRATIVE

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LPA reviewed 3 out of 4 residents and R2’s hospital discharge. Based on records review, there were no indication of residents being diagnosed with scabies. With regards to R2 who was sent out to the hospital due to rashes, LPA Singh indicated in the report that R2 was prescribed Prednisone 10 mg and Triamcinolone Acetonide 0.1% cream. There was no mention of scabies diagnosis. Therefore the facility did not notify residents’ family members.

On October 8, 2021, LPA Fontanilla consulted with the Program Clinical Consultant Supervisor via email if the two medicines prescribed to R2 are used to treat scabies. Nurse Consultant Supervisor states that “Not really the treatment for scabies, Prednisone and triamcinolone cream were probably prescribed for the rash, itching or if there’s any inflammation.”

On October 11, 2021, LPA interviewed S7 and S3. S7 states there were residents who had rashes around November 2019 but staff were not made aware if residents have scabies. S7 denied getting infected with scabies. S3 states that “every time there is something going on, Front desk or caregivers would let me know.”

Based on interviews conducted and records reviewed, the above allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC9099 (FAS) - (06/04)

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