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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191501662
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:10:14 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
COMPLAINT CONTROL NUMBER: 28-AS-20240808160230
FACILITY NAME:BRETHREN HILLCREST HOMESFACILITY NUMBER:
191501662
ADMINISTRATOR:KEITH KASINFACILITY TYPE:
741
ADDRESS:2705 MOUNTAIN VIEW DRIVETELEPHONE:
(909) 593-4917
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY:574CENSUS: 51DATE:
02/18/2025
UNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Kevin Kasin, Administrator TIME COMPLETED:
04:13 PM
ALLEGATION(S):
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Staff do not have adequate staffing to meet resident's needs.
INVESTIGATION FINDINGS:
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LPA made subsequent visit to deliver revised report.The subsequent visit is to provide additional information and clarification not included on the previous reports dated and 08/16/24 and 10/25/2024 02/18/2025. Also new report corrected name at the end of report. LPA met with Administrator Keith Kasin and discussed the purpose of the visit.
This report supersedes report 10/25/2024 It was created to add additional information and nothing else has change. The findings remain the same.
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, and six (6) (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: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
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 4
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: 02/18/2025
NARRATIVE
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(continued from 9099C)

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.


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. Four (4) of six (6) residents interviewed confirmed concerns with staffing: one disclosed there is one staff on shift at night and when the resident called for help it took forty-five minutes for staff to respond, one stated there was a staffing problem, one stated staff are not capable of meeting residents needs and one stated staff are overworked which poses a potential risk to resident in care. 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 shows, one (1) staff assigned to Birch Court, and one (1) staff assigned to Cedar Court each day. The schedule for August 2024 shows two (2) staff scheduled for Southwoods 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.

(Continued on 9099C)

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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: 02/18/2025
NARRATIVE
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(Continued on 9099C)

Based on interviews which were conducted with staff, residents 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 Administrator Kevin Kasin along with the Appeals Rights.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2025
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements – General.
Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…
This requirement is not being met as evidenced by:
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Facility is to adhere to Section 87411 at all times. Administrator is to submit facility’s current personnel policies including staff coverage and work schedules to the licensing agency for review. The facility’s ratio of staff to residents in both assisted living and memory care and a current LIC500 must be included by POC due date.
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Staff interviews disclosed six out of ten staff felt there was an insufficient number of staff during the night shift. Four of six residents interviewed confirmed concerns with staffing: one disclosed there is one staff on shift at night and when the resident called for help it took forty-five minutes for staff to respond, one stated there was a staffing problem, one stated staff are not capable of meeting residents needs and one stated staff are overworked which poses a potential risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4