191501662-10-24-2023-28-AS-TVAO-CXCNRK-20231107094138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191501662
Report Date: 10/24/2023
Date Signed: 10/24/2023 01:20:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
10/16/2023 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231016162911

FACILITY NAME:	BRETHREN HILLCREST HOMES		FACILITY NUMBER:	191501662
ADMINISTRATOR:	KEITH KASIN		FACILITY TYPE:	741
ADDRESS:	2705 MOUNTAIN VIEW DRIVE		TELEPHONE:	(909) 593-4917
CITY:	LA VERNE	STATE: CA	ZIP CODE:	91750
CAPACITY:	574	CENSUS: 86	DATE:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Desiree Eudave - Director of Resident Care		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident's refrigerator is in disrepair.
Facility does not have sufficient maintenance support staff over the weekend.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Desiree Eudave and explained the reason for the visit.

The investigation consisted of the following: LPA requested copies of staff/resident roster, conducted a tour of 9 assisted living resident rooms; room #170, 174,176,178,233,236,237,243, and 278. LPA interviewed 7 residents and 7 staff. LPA requested copies of assisted living staff schedule.

The investigation revealed the following: Regarding allegations: Resident’s refrigerator is in disrepair and Facility does not have sufficient maintenance support staff over the weekend. It is alleged resident’s refrigerator was not working, it is unknown how long the refrigerator was not working, and maintenance staff is not available on the weekends to assist.

(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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

Control Number 28-AS-20231016162911

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BRETHREN HILLCREST HOMES	FACILITY NUMBER: 191501662
	VISIT DATE: 10/24/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interviews conducted with residents revealed, 7 out of 7 residents interviewed stated their appliances, including refrigerator have been in working condition. 1 out of the 7 residents mentioned that the refrigerator currently in the apartment had been placed within the last 4 days and was not able to provide further information due to cognitive skills. Per residents, staff respond quickly to residents’ work order reports. The turnaround to fixing something is no later than the same day, including weekends. Interviews with staff revealed, 7 out of 7 staff interviewed stated facility has a security staff on duty 24 hours every day to which the reports can be made, and who will route or provide the services accordingly on the weekends. Other than that, there is a work order line to which residents report any work order services. Per Director of Facility Operation on 10/14/23, he received a call around 5:00pm reporting a refrigerator was not working. At 5:45pm the staff arrived at the facility and replaced the refrigerator with a temporary refrigerator, as a permanent refrigerator attempted to be place in the room did not fit through the door. An order for a fitting refrigerator has been placed and will be put in the resident’s room once it arrives. Per staff, appliances are kept in the facility’s storage room which allows the facility to provide appliances upon a resident reporting an appliance is out of order. Staff also stated that staff are on call when not available at the facility after working hours. Interview with housekeeper serving Resident #1’s room did not observe any issues with the refrigerator within the last three weeks. Interview with Operations Coordinator who receives all the work orders, stated there have not been any work orders received prior to 10/14/23 for a refrigerator being out of order. LPA observed 9 refrigerators/freezers in the residents’ rooms, each seem in working order. Although the allegations may have occurred, the facility responded within two hours to the report of the refrigerator not working and provided a working refrigerator within a window of 2 hours. Although maintenance manager was not scheduled on Saturday, a technician was on schedule until 4:00pm. After hours the manager and director were on call and responded to the call and provided assistance within 45 minutes.

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

Exit interview was conducted with Desiree Eudave and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2