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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002932
Report Date: 09/24/2024
Date Signed: 09/24/2024 11:04:42 AM


Document Has Been Signed on 09/24/2024 11:04 AM - 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:
09/24/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Keila O'FarrellTIME COMPLETED:
11:30 AM
NARRATIVE
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On September 24, 2024 at approximately 10:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Hilltop Springs Senior Living for the purpose of conducting a Case Managemen-Deficiencies Inspection. LPA met with the Administrator, Keila O'Farrell.

On September 20, 2024, Med Tech was training another staff member when residents were administered medication in the dining room. Resident that received the medication from the staff member trainee was wrong. The trainee noticed the medication error and brought this up to the Med Tech. Primary Care Physician and Responsible Party were notified.

On September 23, 2024, a resident requested a pain pill and then was given the wrong medication. Med Tech observed the error during checks. Primary Care Physician and Responsible Party were notified (See LIC 809D). LPA educated the Administrator on the importance of ensuring that all residents are given the correct dosage of medications per physician orders. LPA advised to send both incident reports to Community Care Licensing Division (CCLD).

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 along with Appeal Rights.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
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 09/24/2024 11:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2024
Section Cited
CCR
87465(b)

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87465(b) Incidental Medical and Dental Care

(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication.

This requirement was not met as evidenced by:
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Licensee shall submit an LIC 9098-Self Certification. In addition, Licensee shall conduct staff training with ALL staff. Licensee/Administrator provide a statement on how future compliance will be met.
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Based on interviews with the Administrator, there were two incidents of Medication Errors that occured on September 20, 2024 and September 23, 2024 which is an immeidate health, safety and personal rights risk to the residents in care.
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Plan of Correction due date: September 25, 2024.

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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: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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