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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002932
Report Date: 09/19/2024
Date Signed: 09/19/2024 01:07:53 PM


Document Has Been Signed on 09/19/2024 01:07 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:HILLTOP SPRINGS SENIOR LIVINGFACILITY NUMBER:
455002932
ADMINISTRATOR:O'FARRELL, KEILAFACILITY TYPE:
740
ADDRESS:7 HILLTOP DRTELEPHONE:
(530) 395-1777
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:211CENSUS: 166DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator, Keila O'FarrellTIME COMPLETED:
01:15 PM
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On September 19, 2024 at approximately 12:00 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Hilltop Springs Senior Living for the purpose of conducting a Case Managemen-Incident Inspection. LPA met with the Administrator, Keila O'Farrell and Assistant Administrator, Jessica Martensen.

On September 10, 2024, Community Care Licensing Division (CCLD) received an incident report indicating that a resident was stuck in a elevator for 30-40 minutes. The resident was panicking when the incident occurred. The elevator was serviced that same day. LPA toured the facility which included the tour of where the elevator is located. LPA took a ride on the elevator and observed no concerns with the movement of the elevator and the opening of the elevator doors. LPA reviewed the Elevator Permit and found that to be appropriate. The Elevator Permit was issued on June 2024. LPA attempted to interview the resident in care but was unsuccessful. Resident was out of the facility on an outing. LPA requested the following document:

-Receipt of elevator servicing

No deficiencies were observed or cited during today's Case Management-Incident Inspection. Exit interview was conducted, and a copy of this report was signed and given to the Administrator.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024
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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