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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002932
Report Date: 01/23/2024
Date Signed: 01/23/2024 09:24:27 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
11/09/2023 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20231109103951
FACILITY NAME:HILLTOP SPRINGS SENIOR LIVINGFACILITY NUMBER:
455002932
ADMINISTRATOR:PURKEY, SIMEONFACILITY TYPE:
740
ADDRESS:7 HILLTOP DRTELEPHONE:
(503) 391-9999
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:211CENSUS: 60DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:SUSAN MOSBYTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Uncleared staff are working at the facility.
INVESTIGATION FINDINGS:
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On 01/23/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 11/09/23. LPA Gurriere met with , Susan Mosby, Health Services Manager and explained the purpose of the visit.

Uncleared staff are working at the facility.

During the interview process, a walk-through of the facility was conducted, and nine staff files were reviewed. In addition, the administrator, four staff persons and three residents were interviewed.


continued
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
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 8
Control Number 59-AS-20231109103951
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: 01/23/2024
NARRATIVE
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During the investigation, documents were obtained and reviewed to include the Staff Records Review document, staff names and cell numbers and the staff listed on the Guardian Roster Report. During the walk-through staff were present and a review of their fingerprint clearances and associations were determined. Nine staff person records were reviewed and out of the nine staff persons, three were not associated with the Hilltop Springs Senior Living facility. Although the three staff members were either cleared or pending clearance, the three staff members were associated to the facility’s sister facility in southern California. It was reported that the facility was associating most of their staff through the sister facility; however, the administrator was advised during the visit that staff should be associated with the facility that they are working in.

Based on investigation observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D.

Appeal Rights were explained and provided to the facility representative listed above and an exit interview was conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 8 of 8
Control Number 59-AS-20231109103951
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: 01/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2024
Section Cited
CCR
87355(c)(1)
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Criminal Record Clearance - A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department: A signed Criminal Background Clearance Transfer Request, LIC 9182.
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The administrator agrees to submit to the licensing agency the transfer/criminal record clearance documents for the three staff persons listed.
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This requirement was not met as evidenced by: Based on interviews of staff persons and records reviewed, the licensee did not ensure that three staff persons were associated to the appropriate facility. This poses an immediate risk to residents in care.
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Facility is served a $1500.00 civil penalty for not having three staff persons associated to the Hilltop Springs Senior Living facility.
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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) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 8
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
11/09/2023 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20231109103951

FACILITY NAME:HILLTOP SPRINGS SENIOR LIVINGFACILITY NUMBER:
455002932
ADMINISTRATOR:PURKEY, SIMEONFACILITY TYPE:
740
ADDRESS:7 HILLTOP DRTELEPHONE:
(503) 391-9999
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:211CENSUS: 60DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:SUSAN MOSBYTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Staff are not adequately trained/qualified.
The facility kitchen is not maintained clean.
The facility food is not of good quality.
The facility does not provide an adequate activity program for the residents.
The facility does not provide a safe environment for the residents.
INVESTIGATION FINDINGS:
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On 01/23/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 11/09/23. LPA Gurriere met with Susan Mosby, Health Services Manager and explained the purpose of the visit.

Staff are not adequately trained/qualified.

During the interview process, a walk-through of the facility was conducted, and nine staff files were reviewed. In addition, the administrator, four staff persons and three residents were interviewed.


continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 59-AS-20231109103951
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: 01/23/2024
NARRATIVE
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During the investigation, five staff training files were reviewed. Documents were obtained and reviewed to include Direct Care Staff Initial Orientation Training which indicates a checklist of 20 hours of training before working independently and 20 hours of training within the care providers first four weeks. A copy of the Certreo California RCFE Orientation Program is the training module that the licensee uses and “hands on” training is provided to the care providers. In addition, interviews were conducted and overall, it was stated that the staff persons have received adequate training to provide care for and supervision to the residents.

Facility Kitchen is not maintained clean.
During the facility walk through, the kitchen was observed. There were approximately five staff persons working in the kitchen preparing the lunch menu. The kitchen was observed to be clean, safe, and sanitary. There were no signs of rodent droppings or unsanitary conditions. The lunch menu was available and posted for the staff persons and for the residents.

Facility food is not of good quality.
During the facility walk through, dry food, refrigerated items and freezer items were observed. The facility was observed to have an abundance of bread, cookies, pastries, beef, chicken, fish, ham, vegetables, potatoes, turkey meat, cranberries, raisins, hash browns, gravy, biscuits, etc. The items appeared to be of high quality and were fresh.

Facility does not provide an adequate activity program for the residents.
During the walk through, the activities director was present. A calendar of activities was posted and available for residents. A copy of the calendar was provided to LPA Gurriere and had numerous daily activities to include Bridge, Pinochle, bible study, bowling, dominos, swimming, aerobics, fitness exercise, karaoke sing along, holiday party, poker night, etc. Special events this month include Greeting card making, gardening event, church carolers, art show, Shasta High Madrigal Singers, and a big band event. The facility provides a pool, a gym, and a bowling alley for the residents’ use. The activities director works 40 hours per week and has been employed since 06/03/23.

During the walk through, three residents were interviewed. Two residents advised that they do participate in the activities; one resident was bowling during the visit. The third resident reported that she does not want to participate in the activities and that she knows that activities are provided if she changes her mind.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 59-AS-20231109103951
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: 01/23/2024
NARRATIVE
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Facility does not provide a safe environment for the residents.
During the complaint intake, it was stated that there was a concern that the independent residents are mingling with the assisted living residents during pool time. Various pool activities are offered to the residents. The independent residents have a key "fob" that they use to enter the pool. The assisted living residents are required to have a care provider let them into the pool area. Dementia residents are not using the pool.

The administrator indicated that there was one resident that likes to use the pool without care and supervision from a staff person. The facility is reminded that the facility shall follow regulation 87464(f)(1)(c) which states “Care and supervision means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered…”

Although the above allegations mentioned may have happened, or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and all of the above findings are Unsubstantiated.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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
11/09/2023 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20231109103951

FACILITY NAME:HILLTOP SPRINGS SENIOR LIVINGFACILITY NUMBER:
455002932
ADMINISTRATOR:PURKEY, SIMEONFACILITY TYPE:
740
ADDRESS:7 HILLTOP DRTELEPHONE:
(503) 391-9999
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:211CENSUS: 60DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:SUSAN MOSBYTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Facility falsifies staff records.
Staff do not maintain residents’ records in an orderly fashion.
INVESTIGATION FINDINGS:
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On 01/23/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 11/09/23. LPA Gurriere met with Susan Mosby, Health Services Manager and explained the purpose of the visit.

Facility falsifies staff records.

During the interview process, a walk-through of the facility was conducted, and nine (9) staff files were reviewed. In addition, the administrator, four staff persons and three residents were interviewed.



continue
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 59-AS-20231109103951
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: 01/23/2024
NARRATIVE
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During the investigation, the staff records were reviewed to include staff at the facility during the walk through and the management CEO team. All required records were available and in the facility files. There were no falsified staff records observed or found.

Staff do not maintain residents’ records in an orderly fashion.
During the investigation and walk through, the resident records five (5) were reviewed to include current residents residing at the facility. All records were available for review and were complete and in order, as required.

Due to the information above, the Department finds the allegations to be Unfounded. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted, copy of report provided.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 8