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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002932
Report Date: 09/05/2024
Date Signed: 09/05/2024 10:20:40 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
08/06/2024 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20240806104318
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
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Keila O'FarrellTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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9
Resident is eloping due to lack of supervision
Facility is not safeguarding resident’s personal items
Medication mismanagement
INVESTIGATION FINDINGS:
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On September 5, 2024, at approximately 09:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Hilltop Springs Senior Living for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Keila O'Farrell, and was granted access into the facility.

During the course of the investigation, LPA reviewed resident records, interviewed the residents in care and staff. In addition, LPA made observations and toured the facility on August 6, 2024.

Complaint alleges Resident is eloping due to lack of supervision. Based on review of incident reports from April 25, 2024, LPA learned that there were two residents that were identified as eloping from the facility but returned to the facility and back into placement the same day (See LIC 9099D). Furthermore, during an interview with the Administrator on August 6, 2024, LPA learned that the resident in question has eloped in passing due to an issue with the egress door during said date of elopement. The egress door was fixed in June 2024. (Report continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 59-AS-20240806104318
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: 09/05/2024
NARRATIVE
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Complaint alleges that facility is not safeguarding resident’s personal items. During the investigation, LPA interviewed staff and learned that a pair shoes that belonged to the resident went missing and could not be found. LPA was made aware during an email conversation on August 7, 2024, the Administrator disclosed that the facility ordered a new pair of shoes for the resident. LPA educated the Administrator on ensuring that Safeguards for Resident Cash, Personal Property, and Valuables are being implemented throughout the facility as outlined in Title 22 regulations (See LIC 9099D).

Complaint alleges Medication mismanagement. Based on a record review of a random sample of residents in care, the preponderance of evidence standard has been met regarding the facility mismanaging resident’s medications (See LIC 9099D).

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.
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
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
08/06/2024 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20240806104318

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
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Keila O'FarrellTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not meeting resident’s needs resulting in repeated UTIs
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
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9
10
11
12
13
On September 5, 2024, at approximately 09:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Hilltop Springs Senior Living for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Keila O'Farrell and was granted access into the facility.

During the course of the investigation, LPA reviewed resident records, interviewed the residents in care and staff. In addition, LPA made observations and toured the facility on August 6, 2024.

Complaint alleges Facility is not meeting resident’s needs resulting in repeated UTIs. Based on interviews that were conducted, LPA could not prove or disprove the above allegation. Furthermore, LPA received inconsistent statements during the investigation.

(Report continued on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 59-AS-20240806104318
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: 09/05/2024
NARRATIVE
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A finding that the complaint allegation of Facility is not meeting resident’s needs resulting in repeated UTIs are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of this was 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: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 59-AS-20240806104318
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: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2024
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements – General

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.

This requirement was not met as evidenced by:
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Licensee shall submit an LIC 9098 understanding of the regulation and conduct staff training as it relates to elopement Procedures. Furthermore, Licensee shall submit a plan for future compliance and a facility roster to reflect appropriate staffing is available to residents in care.
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Based on record review of incident reports, LPA was able to identify two residents that eloped from the facility in April 22, 2024, which presents an immediate health, safety, and personal rights risk to the residents in care.
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POC due date: September 6, 2024
Type A
09/06/2024
Section Cited
CCR
87465(a)(4)
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87465(a)(4) Incidental Medical and Dental Care


(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:

(4) The licensee shall assist residents with self-administered medications as needed.

This requirement was not met as evidenced by:
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Licensee shall submit an LIC 9098 understanding of the regulation and conduct staff training as it relates to ensuring that Title 22 regulations are being followed at the facility. Furthermore, Licensee shall submit a plan for future compliance.
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Based on a record review of a random sample of residents in care, the preponderance of evidence standard has been met regarding the facility mismanaging resident’s medications which presents an immediate health, safety and personal rights risk to the residents in care.
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POC due date: September 6, 2024
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: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 59-AS-20240806104318
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: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/12/2024
Section Cited
CCR
87217(b)
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87217(b) Safeguards for Resident Cash, Personal Property, and Valuables

(b) Every facility shall take appropriate measures to safeguard residents’ cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources.

This requirement was not met as evidenced by:
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Licensee shall submit an LIC 9098 understanding of the regulation and conduct staff training as it relates to Safeguards for Resident Cash, Personal Property, and Valuables. Furthermore, Licensee shall submit a plan for future compliance.
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9
10
11
12
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Based on interviews that were conducted on August 7, 2024 with the Administrator, a pair of shoes went missing that could not be found and that the facility had to purchase new shoes for the resident in care which presents a potential health, safety and personal rights risk to the residents in care.
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POC due date: September 12, 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: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6