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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607488
Report Date: 03/03/2022
Date Signed: 03/03/2022 11:30:56 AM


Document Has Been Signed on 03/03/2022 11:30 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:HERITAGE POINTEFACILITY NUMBER:
300607488
ADMINISTRATOR:MIKE SILVERMANFACILITY TYPE:
740
ADDRESS:27356 BELLOGENTETELEPHONE:
(949) 364-9685
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:225CENSUS: 143DATE:
03/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Tracii Brown, Director of Healthcare TIME COMPLETED:
11:40 AM
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Licensing Program Analysts (LPAs) Kathrina Chin and Jessica Cho conducted an unannounced required annual inspection of this facility. LPAs met with Tracii Brown, Director of Healthcare and stated the purpose of this visit.

LPAs were granted entry after completing the COVID-19 screening procedure. Facility has 143 residents. LPAs toured the interior and exterior portions of the facility. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide, and auditory exit alarms were operational. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water was measured at 113 degrees Fahrenheit in memory care and 115.8 degrees Fahrenheit in assisted living resident bathrooms. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies, and sharp items were inaccessible to residents in care. Fire extinguishers were mounted and charged. For the exterior portion, facility has several patio furnitures with umbrellas for shade and the grounds were free of tripping hazards. LPAs observed the emergency disaster and evacuation plans. Facility has back-up emergency food and water supply as well as PPE supplies.

LPAs reviewed the COVID-19 mitigation plan of the facility.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

LPAs conducted an exit interview with Tracii Brown, Director of Healthcare and copy of this report was left in the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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