191501662-10-25-2024-28-AS-LHIS-DFSKUF-20250416081233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191501662
Report Date: 10/25/2024
Date Signed: 10/25/2024 06:01:28 PM

Substantiated

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
08/08/2024 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240808160230

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: 62	DATE:	10/25/2024
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Desiree Eudave, Supervisor, Keith Kasin, Administrator		TIME COMPLETED:	09:27 AM

ALLEGATION(S):

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Staff do not have adequate staffing to meet resident's needs.

INVESTIGATION FINDINGS:

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This report supersedes report dated 08/16/2024. It has been revised to correct grammatical errors. Nothing else has changed.

Licensing Program Analyst (LPA) Alberto Lopez conducted subsequent complaint visit to address the above allegation. LPAs met with Desiree Eudave, Supervisor and Keith Kasin, Administrator. LPA explained the reason for the visit.

08/16/2024 On this date, LPA interviewed six (6) staff six (6) residents from Assisted Living and LPA also obtained staff and resident roster and reviewed and obtained two (2) residents' relevant medical documentation, and current training documentation. LPA asked for R6 Woods discharge paperwork and updated LIC602 to be emailed and proof of emergency disaster training for night shift staff.

(continued on 9099C)

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

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 28-AS-20240808160230

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: 10/25/2024

NARRATIVE

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(continued from 9099)

10/15/2024 LPA interviewed a total of ten (10) staff including staff previously interviewed on earlier visit. LPA interviewed one (1) additional resident. LPA interviewed six (6) residents total and LPA obtained R6 file and 08/2024 and 10/2024 staff schedule

Allegation: Staff do not have adequate staffing to meet resident's needs. It is alleged that facility does not have enough staff to meet resident's needs during the overnight shift. LPA interviewed ten (10) staff, and seven (7) of ten (10) staff corroborated the allegation. LPA interviewed six (6) residents, and five (5) of six (6) residents were able to corroborate the allegation. Some residents stated staff are very good, but sometimes it takes a long time to assist them during the overnight shift. Some staff interviewed stated that they were stretched thin, and have to leave their assigned building to go to another building to administer medications, or assist residents without any staff during that time. Some staff stated the overnight security guard assists them with residents at times. S2 and S9 also corroborated the allegation and stated, at times, the security guard will assist staff with lifting residents who have fallen overnight. Review of staff schedule for the month of August 2024 states, one (1) staff assigned to Birch Court, and one (1) staff assigned to Cedar Court each day. The schedule for August 2024 states two (2) staff scheduled for Southwood Memory Care each day, one (1) Med-Tech (MT), and one Resident Assistant (RA). The October 2024 schedule shows one (1) staff at Cedar Court building for the overnight shift, one (1) staff at Birch Court, and two (2) staff at Memory Care each night. The fact that staff have to seek the security guard’s assistance at times is evidence that facility does not have enough staff to meet the resident's needs during the overnight shift.

Based on interviews which were conducted with staff and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to the Supervisor Desiree Eudave along with the Appeals Rights.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

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