Facility Evaluation Report

Telecare Hillside House, Antioch05/21/2025Licence 079201018

Capacity4
Census4
Date signed05/21/2025 01:17:16 PM
Name of licensing program analystLaura Hall
Name of licensing program managerHarpreet Humpal
The inspector’s account

On 5/21/2025 at 12:00pm, Licensing Program Analysts (LPAs) L. Hall and Y. Brown conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 5/17/2025. LPA met with Jesse Mendenhall, Administrator and explained the purpose of the visit.

The incident reported occurred on 5/13/2025 and 5/14/2025. The report stated on 5/16/2025, S2 was conducting a count of the medication and observed there were two (2) missing pills that should have been given to C1 on 5/13/2025. On 5/16/2025, S2 was conducting a count of the medication and observed there was one (1) pill missing that should have been given to C1 on 5/14/2025. S1 stated during visit that the medication was not given according to medication count.

*An immediate $250.00 civil penalty will be assessed on today's date for repeat deficiency*

The deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties

Exit interview conducted. A copy of the LIC421FC and this report provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction