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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604595
Report Date: 09/23/2024
Date Signed: 09/23/2024 04:37:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2024 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20240621105233
FACILITY NAME:HILLTOP HOME CARE CENTERFACILITY NUMBER:
374604595
ADMINISTRATOR:ANTONIO, JANE ARLYN H.FACILITY TYPE:
735
ADDRESS:110 ORANGE DRIVETELEPHONE:
(619) 777-3746
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:4CENSUS: 2DATE:
09/23/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Caregiver Jave Vega and Licensee Gil AntonioTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee’s staff yelled at client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Jave Vega. LPA then met with Licensee Gil Antonio, who arrived later during the visit.

The Complainant alleged that facility Staff #1 (S1) yelled at Client #1 (C1). [See LIC811 Confidential Names List for a description of select person identifiers used.] CCLD’s investigation involved multiple unannounced facility tours/welfare checks and collateral visits. The Department also interviewed all clients, pertinent facility staff, and multiple outside sources, and reviewed relevant care and personnel records.


[CONTINUED ON LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
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 08-AS-20240621105233
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: HILLTOP HOME CARE CENTER
FACILITY NUMBER: 374604595
VISIT DATE: 09/23/2024
NARRATIVE
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[CONTINUED FROM LIC 9099]

In their interviews, C1 and their housemates denied that S1 or any other facility staff shouted/yelled at them. S1 also denied the allegation. LPA observed during his multiple facility visits that C1 frequently exhibited behaviors that required staff redirection; interviews of staff and other clients confirmed this. C1 admitted to LPA that they sometimes yelled at S1 and other facility staff but said staff do not yell back at them.

However, in separate interviews, three (3) other sources corroborated they witnessed and/or heard S1 become frustrated with C1, shouting/yelling at C1. In each of these instances, the witnesses said S1 was trying to get C1 to do something, but S1’s emotion and volume were concerning. There was no indication of S1 using profane language towards C1.

Based on interviews, a preponderance of evidence exists to show that Licensee’s staff (S1) yelled at a client (C1). The allegation is therefore Substantiated. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). A Plan of Correction were jointly developed with the Licensee.

An exit interview was conducted with Gil Antonio, to whom a copy of this report, the LIC 9099-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240621105233
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HILLTOP HOME CARE CENTER
FACILITY NUMBER: 374604595
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2024
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights: “(a)…each client shall have personal rights, which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.” This requirement was not met, as evidenced by:
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As of the date of deficiency issuance, C1 has moved out and no longer lives at the facility. Licensee agreed to conduct documented individual performance coaching/counseling with S1. Licensee also agreed to retrain all current direct care staff (to include S1) on Clients’ Personal Rights (as articulated in CCLD form LIC613) and how to correctly manage challenging client behaviors. Licensee agreed to E-mail a copy of S1’s performance coaching and the team training sign-in sheet to LPA, by the POC due date.
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Based on interviews, the Licensee did not ensure that 1 of 3 clients (C1) was accorded dignity in his/her personal relationships with staff. This posed a potential Personal Rights risk to persons 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.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3