300607488-12-9-2021-22-AS-AORZ-CL2V42-20221110150537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 12/09/2021
Date Signed: 12/09/2021 02:16:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2021 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210614115537

FACILITY NAME:	HERITAGE POINTE		FACILITY NUMBER:	300607488
ADMINISTRATOR:	MIKE SILVERMAN		FACILITY TYPE:	740
ADDRESS:	27356 BELLOGENTE		TELEPHONE:	(949) 364-9685
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	225	CENSUS: 151	DATE:	12/09/2021
		UNANNOUNCED	TIME BEGAN:	12:13 PM
MET WITH:	Mike Silvermen, Executive Director and Tracii Brown, Director of Health Care.		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Insufficient staffing to meet the residents' needs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an announced visit for the purpose to conclude findings for the allegation listed above. LPA Quiroz met with Mike Silvermen, Executive Director. The initial 10-day visit for this complaint was completed on 6/18/2021 by LPA Kimberly Lyman.
During today's visit, LPA Quiroz conducted interviews, conducted facility tour inspection along with ED Mike Silvermen and conducted observations primarily focusing on staffing meeting resident's needs, reviewed documents including but not limited to: call log for today's date, staff schedules, resident roster,and Resident 1 (R1) file.
It was alleged that "Insufficient staffing to meet the resident's needs." During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, and conducted facility tour focusing on observations related to resident's needs. Four of Four interviewees did not corroborate with the allegations. While touring Memory Care LPA Quiroz observed Four staff to ten resident ratio, and on today's date there are five caregivers, two Licensed Vocational Nurses, one Registered Nurse and two Medication Technicians scheduled on Assisted Living. CONTINUED ON NEXT 9099 C PAGE...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

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 2

Control Number 22-AS-20210614115537

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HERITAGE POINTE	FACILITY NUMBER: 300607488
	VISIT DATE: 12/09/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on a review of the documentation, observations and interviews conducted, this department has found the complaint allegation of "Insufficient staffing to meet the resident's needs," is deemed UNSUBSTANTIATED; meaning although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

This report was reviewed with Executive Director Mike Silvermen and Tracii Brown Director of Health Care. A copy of this report was provided at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2