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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191501662
Report Date: 06/14/2022
Date Signed: 06/14/2022 06:11:14 PM

Unsubstantiated


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
03/25/2021 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210325122412
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: 68DATE:
06/14/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:CEO, Matthew Neeley TIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Resident's hygiene needs were not met.
Staff did not effectively communicate with resident's family.
Facility lacked sufficient staff to meet resident's needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Christine Wong and Bennette Pena conducted a subsequent complaint visit to address the above allegations. LPAs met with Director of Social Work- Lynn Palin and explained the reson of the visit. Later on, CEO Matthew Neeley also joined and assisted with the visit.

The investigation consists of the following: LPAs interviewed the director of Social work, CEO of Hillcrest, four residents from Assisted Living and two resident from Memory Care unit and LPA also obtained staff and resident roster and reviewed two residents' medication from Memory Care Unit

The investigation revealed of the following: Allegation#1 " Resident's hygiene needs were not met." LPA interviewed all four residents in Assisted Living and all denied the allegation and reported all staff take good care of them and all the staff are wonderful and all their needs are being met.

(See LIC 9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
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 6
Control Number 28-AS-20210325122412
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: 06/14/2022
NARRATIVE
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LPAs also observed all residents are clean and dress appropriately and have no long fingernails.Based on the evidence, interviews conducted and the finding is UNSUBSTANTIATED.

Allegation#2 "Staff did not effectively communicate with resident's family." LPA interviewed residents and they all denied the allegation and reported staff are very good at communicating wth their families. They always notified their families if there's any change of health condition. The director of Social Work also reported it is their protocol to notify the family if anything happened to the residents including any health condition got changed or fall or hospitalized. They have to report it to the resident family immediately. Based on the evidence, interviews conducted and the finding is UNSUBSTANTIATED.

Allegation#3 " Facility lacked sufficient staff to meet resident's needs." LPA interviewed residents and all denied the allegation and reported there are always sufficient staffing in the facility even during the Covid peak time. The staff are always available there to help them. The staff never delayed their assistance for help. LPA interviewed staff and reported they have about five registry contract during the COVID and they still used the registry at the present time. They were never lacking of staff. Also there were no resident ever complained lacking of staff in the facility. Based on the evidence, interviews conducted and the finding is UNSUBSTANTIATED.

Based on the interviews conducted with staff and residents, record review and LPA's observation, 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 are all UNSUBSTANTIATED.

An Exit Interview was conducted. The copy of the report and appeal right were provided to CEO Matthew Naelley
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
03/25/2021 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210325122412

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: 68DATE:
06/14/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:CEO Matthew Neeley TIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff did not properly manage resident's medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Christine Wong and Bennette Pena conducted a subsequent complaint visit to address the above allegation. LPAs met with Director of Social Work- Lynn Palin and explained the reson of the visit. Later on, CEO Matthew Neeley arried and assisted with the visit.

The investigation consists of the following: LPAs interviewed the director of Social work, CEO of Hillcrest, four residents from Assisted Living and two resident from Memory Care unit and LPA also obtained staff and resident roster and reviewed two residents' medication from Memory Care Unit

The investigation revelaed of the following: Allegation "Staff did not properly manage resident's medication." LPA interviewed resident and reported all their medication are managed well with the staff. LPA reviewed Resident#1 (R1) medication and obserevd R1's medication for Quetiapine 25mg (Take 1 tablet by mouth at bed time) was not in the facility and R1 did take one tablet last night. (See LIC 9099C for continuation)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20210325122412
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: 06/14/2022
NARRATIVE
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The staff reported the medication was ordered since June 12, 2022 and the pharmacy should be delivered today. In addition, LPA also reviewed R1's medication record from the computer system and indicated that R1 was not taken the medication of Quetiapine from June 5th to June 11th and there's no notes documented why R1 was not taking the medication. The computer system indicated that R1 did not receive her dosage until June 12, 2012. Staff was not sure if R1 refused or R1 did not eat the food as the medication needs to be crushed in the food. CEO Matthew also reported the new computer medication system was just installed recently and staff may need more training. Based on the evidence, interviews conducted and documents provided the finding is SUBSTANTIATED.

Based on LPA’s observations and interviews which were conducted, 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 CEO Matthew Neeley along with the Appeals Rights.

SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20210325122412
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2022
Section Cited
CCR
87465(j)
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87465 Incidental Medical and Dental Care (j)In all facilities licensed for sixteen (16) persons or more, one or more employees shall be designated as having primary responsibility for assuring that each resident receives needed first aid and needed emergency medical services and for assisting residents as needed with self-administration of medications. The names of the staff employees so responsible and the designated procedures shall be documented and made known to all residents and staff.
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The administrator will ensure all the documentation needs to be done and made known to all residents and staff and the administrator will re-read the regulation and retrain the staff for medication and send the training log and the picture of the medication for Quetapine to LPA by POC due date.
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The requirement is not met as evidenced by LPA's observation and record review, R1's medication Quetiapine 25mg was not taken from June 5th to 11th, 2022 and the staff was not able to explain to LPA why R1 was not taking which is potential risk to residents 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.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6