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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002932
Report Date: 10/20/2023
Date Signed: 10/20/2023 12:06:01 PM


Document Has Been Signed on 10/20/2023 12:06 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:OLSON, DENISEFACILITY TYPE:
740
ADDRESS:7 HILLTOP DRTELEPHONE:
(503) 391-9999
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:211CENSUS: 36DATE:
10/20/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Simeon Purkey AdministratorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced on 10/20/23 to conduct a Health and Safety Inspection. LPA met with Administrator Simeon Purkey and explained the purpose of the visit. LPA and Administrator toured of the facility, LPA reviewed C1's LIC602, service plan, interim service plan and interviewed staff. C1 didn't have a history of leaving the facility and the facility had made arrangements and noted in interim service plan to perform hourly checks on resident after resident's spouse had been hospitalized.



No deficiencies are found as a result of this visit.

Report reviewed and copy provided Administrator Simeon Purkey.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Sarah BensonTELEPHONE: 530-895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2023
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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