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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191501662
Report Date: 09/18/2020
Date Signed: 09/24/2020 04:00:54 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2020 and conducted by Evaluator Renee Arterberry
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200406114039
FACILITY NAME:BRETHREN HILLCREST HOMESFACILITY NUMBER:
191501662
ADMINISTRATOR:MATTHEW NEELEYFACILITY TYPE:
741
ADDRESS:2705 MOUNTAIN VIEW DRIVETELEPHONE:
(909) 593-4917
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY:574CENSUS: 55DATE:
09/18/2020
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Desiree Eudave, Assisted Living Supervisor/ Administrator TIME COMPLETED:
04:06 PM
ALLEGATION(S):
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Staff neglect resulting in resident developing infection
Insufficient staff to meet residents needs
Staff are not properly trained.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ren'ee Arterberry initiated a Complaint Follow-Up Visit pertaining to the allegations noted above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with the Assisted Living Supervisor Desiree Eudave and the purpose for the visit was discussed.

The investigation consisted of the following: on 08/27/2020 the LPA interviewed two administrative staff members and they shall be referred to as, S1 and S2. On 08/28/2020 the LPA randomly selected and interviewed a total of five (5) caregivers and they shall be referred to as: S3, S4, S5, S6 and S7.On 09/02/2020 the LPA attempted to interview a total of five (5) residents who shall be referred to as, R2, R3, R4, R5 and R6 but for various reasons: they were not in their bedroom, mild cognitive disability or sleeping during visit, they were not interviewed. The purpose for today's visit is to interview additional residents. The LPA randomly selected and interviewed five (5) residents who shall be referred to as, R7, R8, R9, R10 and R11. The caregivers interviewed on 08/28/20 are also medication technicians. The Assisted Living Supervisor is
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee ArterberryTELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020
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 3
Control Number 28-AS-20200406114039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BRETHREN HILLCREST HOMES
FACILITY NUMBER: 191501662
VISIT DATE: 09/18/2020
NARRATIVE
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also the Medication Technician Supervisor, S2. All file documents supplied during the previous visit were reviewed; In-Service Training, Personnel Work Schedule, Staff and Resident Roster, Hillcrest Assisted Living Level of Care Worksheet, Hillcrest Assisted Level of Care Worksheet, Physician's Report for Residential Care Facilities for the Elderly (RCFE), Functional Capability Assessment, Hillcrest Assisted Living Service Plan, Hillcrest Assisted Living In-Service Training Sign-In Sheet, Safety Training Meeting Sign In Sheet and COVID-19 Specific Training.

The investigation reveal the following: Staff neglect resulting in resident developing infection: S2 state that she do not monitor or record resident urine output. It is the caregivers responsibility to clean the catheter insertion area, record the urine output on the Catheter Records Sheet, dump the urine bag and to notify her and the resident's physician of any abnormities. If the color or amount of urine is not normal. The caregiver is to immediately notify S2 and the resident's physician. S2 denied that R1 was bleeding for 3 days and as a result developed a UTI. S2 further state that when medical attention was needed R1 was immediately transported to the hospital. The caregivers all state that it is their responsibility to ensure the insertion location is clean, the bag is dumped, the urine output is recorded. If abnormities are observed, they notify S2 and the resident's physician. S7 further state that she was assigned to provide care to R1. R1's urine output was recorded everyday, throughout the day and night. If there were any changes in the color or amount of urine she immediately notified the doctor and then S2. R1's urine and catheter were closely monitored. "Additionally, there is defiantly no way that R1 or any resident would bleed or have blood in their urine and caregivers neglect to make the required notifications and send her to the hospital". Residents R7 through R11 state that their needs are being met and therefore, deny being neglected. Based on the evidence, interviews conducted the funding is unsubstantiated.

Insufficient staff to meet residents needs: It is the responsibility of S2 to ensure that the required amount of staff, including caregivers are working on each shift, to meet the needs of the residents. S2 state that the required amount of facility personnel are on each shift in sufficient numbers to provide the services necessary to meet the resident needs. All staff state that the facility is not short-handed and they are able to provide care and supervision to each resident. Residents R7 through R11 state that their needs are being met and the required amount of caregivers are available. A review of the Personnel Report reveal that the amount of caregivers on each shift, is the required amount to provide care to the current census. Based on the evidence, interviews conducted and documents provided, the funding is unsubstantiated.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee ArterberryTELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20200406114039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BRETHREN HILLCREST HOMES
FACILITY NUMBER: 191501662
VISIT DATE: 09/18/2020
NARRATIVE
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Staff are not properly trained: S2 and S1 state that all staff including medication technicians are trained prior to dispensing medications. S2 also state that all medication technicians receive a minimum of 24 hours of medication training prior to assisting residents with medications. At least 16 of those hours are shadowing senior medication technicians. S2 further state that If a medication technician make a medication error they are subject to Disciplinary Actions; verbal warning, written warning, final warning and if the medication errors continue, termination. All reporting obligations are met: notify the primary care physician, the resident's family and Community Care Licensing.

All medication technicians state that they were medication trained prior to medication distribution. They also state that they shadowed a senior medication technician prior to distributing medications. A review of the In-Service Training documents provided by S2 reveal that medication training; Medication Administration, Medication Documentation, Avoiding Med Errors, Pain Management, Adverse Drug Events was provided in the amount of hours to the medication technicians as required per California Code of Regulations, Title 22 Section 87411. Based on the evidence, interviews conducted and documents provided the funding is unsubstantiated.

The State of California, Department of Social Services Community Care Licensing investigated the allegations of; staff neglect resulting in resident developing infection , Insufficient staff to meet residents needs and staff are not properly trained. The Assisted Living Supervisor/Administrator who is also the Medication Technician Supervisor, the assistant administrator, five (5) caregivers who are also medication technicians and five residents were interviewed. R1 was not interviewed because she did not return to the facility following hospitalization. R1 is deceased prior to this complaint investigation.

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 complaint investigation of the allegations is unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22

An Exit Interview was conducted via telephone with S2 and a hardcopies were provided via email for signatures. Signatures on hardcopies.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee ArterberryTELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3