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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002932
Report Date: 09/05/2024
Date Signed: 09/05/2024 10:37:04 AM


Document Has Been Signed on 09/05/2024 10:37 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: 167DATE:
09/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Administrator, Keila O'FarrellTIME COMPLETED:
09:00 AM
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On September 5, 2024 at approximately 09:00 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Hilltop Springs Senior Living for the purpose of conducting an Case Management-Incident Inspection. Upon arrival, LPA was greeted outside by Administrator, Keila O'Farrell and was granted access into the facility.

During the Case Management-Incident Inspection, pertaining to the incident report dated for July 27, 2024, Administrator reported that Resident #1's Responsible Party was adamant of keeping the resident in Assisted Living instead of Memory Care when the resident moved in to the facility in May 2024. However, the Change of Condition happened when the resident walked passed the supermarket in late July 2024, and that is when the conversation of admitting the resident to Memory Care Unit. Administrator followed-up with the family multiple times and that the main priority was to keep the resident safe. Responsible Party agreed to place the resident in the Memory Care Unit after the elopement.

On July 24, 2024, the facility reported that Resident #2 had a hip fracture while on hospice attempting to get up from the chair in the common area. The incident report reflects that the resident was last seen in the common area before the unwitnessed fall. Subsequently, resident got transferred to the hospital after the fall. Facility was conducting more frequent room checks when the resident returned back to the facility. Resident was on comfort care and was on hospice up until the discharge on August 9, 2024.

On July 10, 2024, the facility reported that Resident #3 when the fall happened the resident was making the bed when the unwitnessed fall occurred. Resident fell, pressed pendent and was subsequently attended to by a staff member.

No deficiencies were observed or cited during today's Case Management-Incident inspection. Exit interview was conducted and a copy of this signed report was given to the Administrator.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
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.

LIC809 (FAS) - (06/04)
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