455002932-9-5-2024-59-AS-KHOS-D92KZC-20240912082031

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002932
Report Date: 09/05/2024
Date Signed: 09/05/2024 10:36:38 AM

Substantiated

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
09/03/2024 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 59-AS-20240903081337

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:	09:00 AM
MET WITH:	Administrator, Keila O'Farrell		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Licensee allows uncleared staff to provide care for residents

INVESTIGATION FINDINGS:

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On September 5, 2024 at approximately 09:00 AM, Licensing Program Analyst (LPA), Farhaan Sarangi conducted an unannounced complaint investigation inspection for the purpose of opening a complaint. LPA met with Administrator, Keila O'Farrell.

During the opening of the complaint, LPA toured the facility and made observations on September 5, 2024. In addition, LPA interviewed the Administrator.

Complaint alleges that Licensee allows uncleared staff to provide care for residents. Based on an interview with the Administrator, LPA learned that the facility just recently hired the staff member to work on the Independent Living side of the facility that is also connected to the Assisted Living side of the facility. LPA conducted a tour of the 1st floor of the facility on September 5, 2024 at approximately 09:00 AM and observed the uncleared staff member cooking food (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)

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Control Number 59-AS-20240903081337

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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LPA educated the Administrator on the importance of ensuring that ALL staff have a Criminal Record Clearance as outlined in Title 22 Regulation 87355(a). Furthermore, a review of the Guardian Background Clearance list on September 5, 2024, reflects that the newly hired staff is "In Process" of obtaining a Background Clearance.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6, Chapter 8 of California Regulation. Appeal rights were provided. Civil Penalty in the amount of $100.00 was issued for the Uncleared Adult. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in additional civil penalties. Exit interview was conducted, and a copy of this report was signed and given to the Administrator along with Appeal Rights.

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 3

Control Number 59-AS-20240903081337

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 87355(a)	1 2 3 4 5 6 7	87355(a) Criminal Record Clearance: (a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator shall submit an LIC 9098 understanding of the regulation. Furthermore, Licensee/Administrator shall submit a statement regarding a plan for future compliance.
	8 9 10 11 12 13 14	Based on an interview with the Administrator and a tour of the facility, the uncleared adult was just recently hired to work on the Independent Living side of the facility that is also connected to the Assisted Living side of the facility. LPA conducted a tour of the 1st floor of the facility on September 5, 2024 at approximately 09:00 AM and observed the uncleared staff member cooking food which is 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
Type A 09/06/2024 Section Cited CCR 87761(b)	1 2 3 4 5 6 7	87761(b) Penalties (b) Notwithstanding Section 87761(a) above, an immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed if any individual required to be fingerprinted under Health and Safety Code Section 1569.17(b) has not obtained a California clearance or a criminal record exemption, requested a transfer of a criminal record clearance or requested and be approved for a transfer of an exemption as specified in Section 87355(e) prior to working, residing or volunteering in the facility.	1 2 3 4 5 6 7
	8 9 10 11 12 13 14	Civil Penalty assessed in the amount of $100.00.	8 9 10 11 12 13 14

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)

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