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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604595
Report Date: 09/23/2024
Date Signed: 09/23/2024 04:48:49 PM

Document Has Been Signed on 09/23/2024 04:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
374604595
ADMINISTRATOR/
DIRECTOR:		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
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Caregiver Jave Vega and Licensee Gil AntonioTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite a deficiency identified during a separate complaint investigation. 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.

Interviews of multiple facility staff and outside sources, corroborated by care progress notes, showed: For a period of time during which Client #1 (C1) lived at the facility, staff would sometimes require C1 to relinquish / turn in their iPad (their personal property) to staff before bedtime at night. The reason for staff taking the iPad away was to encourage C1 to get a good night’s rest, to support C1 being ready to attend off-site day program the next morning. C1’s responsible person and assigned personnel at San Diego Regional Center (SDRC) were aware of this practice.

However, the evidence also showed there were occasions when C1 did not want to turn in their iPad to staff, but they were still required to do so, causing C1 to become frustrated/agitated. After a few months of C1 living at the facility, Licensee directed its staff to stop taking away C1’s iPad, at all.

While facility staff may encourage good habits in clients, they may not force a client to surrender their personal property. Regulation protects a client’s ongoing right to “possess and use his/her own personal items.” One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Gil Antonio, to whom a copy of this report, the LIC 809-D, 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
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/23/2024 04:48 PM - It Cannot Be Edited


Created By: Dang Nguyen On 09/23/2024 at 10:23 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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
85072(b)(6)

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85072 Personal Rights: “(b) The licensee shall insure that each client is accorded the following personal rights. (6) To possess and use his/her own personal items…” 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 retrain all current direct care staff on Clients’ Personal Rights (as articulated in CCLD form LIC613), and to E-mail a copy of the team training sign-in sheet to LPA, by the POC due date.
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Based on records and interviews, the Licensee did not continuously ensure the right of 1 of 3 clients (C1) to possess and use his/her own personal items. 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.
SUPERVISOR'S 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


LIC809 (FAS) - (06/04)
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