455002932-9-5-2024-59-AS-KHOS-D92KVZ-20240912081509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002932
Report Date: 09/05/2024
Date Signed: 09/05/2024 10:25:21 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2024 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 59-AS-20240812144823

FACILITY NAME:	HILLTOP SPRINGS SENIOR LIVING		FACILITY NUMBER:	455002932
ADMINISTRATOR:	O'FARRELL, KEILA		FACILITY TYPE:	740
ADDRESS:	7 HILLTOP DR		TELEPHONE:	(530) 395-1777
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	211	CENSUS: 167	DATE:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Keila O'Farrell		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Untrained staff administering medications
Staff dispensed wrong medications for resident on an outing causing resident to miss medications

INVESTIGATION FINDINGS:

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On September 5, 2024, at approximately 09:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Hilltop Springs Senior Living for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Keila O'Farrell and was granted access into the facility.

During the course of the investigation, LPA reviewed resident records, interviewed a resident in care and the Administrator.

Complaint alleges that Untrained staff administering medications. Based on interviews that were conducted, LPA could not prove or disprove the above allegation. Furthermore, LPA received inconsistent statements during the investigation.

(Report continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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 5

Control Number 59-AS-20240812144823

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HILLTOP SPRINGS SENIOR LIVING	FACILITY NUMBER: 455002932
	VISIT DATE: 09/05/2024

NARRATIVE

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Complaint alleges that Staff dispensed wrong medications for resident on an outing causing resident to miss medications. Based on interviews that were conducted, LPA could not prove or disprove the above allegation. LPA learned that the resident’s significant other was handling this particular medication. Furthermore, inconsistent statements were made during the investigation.

A finding that the complaint allegations of Untrained staff administering medications, Staff dispensed wrong medications for resident on an outing causing resident to miss medications are unsubstantiated meaning that although the allegation 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 allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and given to the Administrator.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2024 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 59-AS-20240812144823

FACILITY NAME:	HILLTOP SPRINGS SENIOR LIVING		FACILITY NUMBER:	455002932
ADMINISTRATOR:	O'FARRELL, KEILA		FACILITY TYPE:	740
ADDRESS:	7 HILLTOP DR		TELEPHONE:	(530) 395-1777
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	211	CENSUS: 167	DATE:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Keila O'Farrell		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not reorder residents medications timely causing resident to miss medications

INVESTIGATION FINDINGS:

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13

On September 5, 2024, at approximately 09:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Hilltop Springs Senior Living for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Keila O'Farrell and was granted access into the facility.

During the course of the investigation, LPA reviewed resident records, interviewed a resident in care and the Administrator.

Complaint alleges that staff did not reorder resident’s medications timely causing resident to miss medications. During an interview on August 13, 2024, at approximately 8:50 AM with the Administrator of the facility, LPA learned that the resident has not had his medication refilled. In addition, during an interview with the resident, LPA confirmed which medication that was not reordered timely causing resident to miss medications (See LIC 9099D). (Report continued on LIC 9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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 5

Control Number 59-AS-20240812144823

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HILLTOP SPRINGS SENIOR LIVING	FACILITY NUMBER: 455002932
	VISIT DATE: 09/05/2024

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Deficiencies cited from the California Code of Regulations, Title 22, Division 6, Chapter 8 of California Regulation. Appeal rights were provided. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted, and a copy of this report was signed and given to the Administrator.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 59-AS-20240812144823

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HILLTOP SPRINGS SENIOR LIVING	FACILITY NUMBER: 455002932
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/05/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/06/2024 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465(a)(4) Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee shall submit an LIC 9098 understanding of the regulation and conduct staff training as it relates to ensuring that Title 22 regulations are being followed at the facility. Furthermore, Licensee shall submit a plan for future compliance.
	8 9 10 11 12 13 14	Based on interviews that were conducted, the Administrator was aware that medications have not been refilled by the facility which presents an immediate health, safety and personal rights risk to the residents in care.	8 9 10 11 12 13 14	POC due date: September 6, 2024
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5