300607488-1-27-2023-22-AS-SSAS-CNL3RZ-20230130172934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 01/18/2023
Date Signed: 01/27/2023 02:52:11 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
12/21/2021 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211221095941

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: 123	DATE:	01/18/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Georgianna Mendez, Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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1/ Staff mishandled a resident's medication while in care

2/ Staff did not follow a physician's orders for a resident

3/ Facility has inadequate record keeping for a resident

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced inspection visit to deliver findings in the investigation of the allegations stated above. LPA was greeted and granted entry by Georgianna Mendez, Administrator after explaining the purpose of the visit and detailing the allegations listed above.

During the investigation, the Department interviewed seven members of staff and attempted or conducted interviews with a total of thirteen (13) residents. LPA additionally reviewed and obtained pertinent documentation, including resident records documenting the interviewed residents status on Medication Management as well as Physician Reports, Medication Administration Records among other documents.

Regarding the allegations that Staff mishandled a resident's medication while in care, that Staff did not follow a physician's orders for a resident and that Facility has inadequate record keeping for a resident, the following was concluded: (CONTINUED ON FORM LIC9099-C) AMENDED TO REFLECT VISIT TYPE CHANGE

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20211221095941

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HERITAGE POINTE	FACILITY NUMBER: 300607488
	VISIT DATE: 01/18/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

A review of the records and interviews concluded that the condition of Resident 1 (R1) was re-assessed by their primary care physician to have evolved to require assistance in the time period between yearly evaluations dated June 20, 2019 and August 20, 2020. The initial report indicates that the resident is noted as being able to self-administer their medication without supervision. The following physician report indicates however that the resident is no longer able to self-administer without supervision.

Despite this change in condition, the resident was not transitioned to medication management status by the facility and formally assisted by facility staff until December 11, 2021 as documented in staff interviews as well as in printouts from the Medication Administration Records provided by the facility. While staff interviews evidenced that there is normally a process for such orders to be documented and the necessary changes implemented, it appeared during the investigation that it had not been the case as far as the care for resident R1 was concerned. These elements confirm that the resident was left to manage her own medication with no formal assistance by the facility for a period of 16 months after a transition to Medication Management was ordered by the physician.

During a visit conducted on February 17, 2022, Licensing Program Analyst (LPA) Kevin Saborit-Guasch was provided R1's file to review. Based on observation, LPA was able to determine that the resident R1’s file did not include the original signed Admission Agreement. Facility administrator confirmed that he was unable to locate the Admission Agreement either in paper or electronic form. A deficiency for this was already cited on April 21, 2022.

Based on the evidence gathered during the investigation, the three allegations listed above are deemed to be substantiated, meaning that the preponderance of evidence standard has been met. Cited deficiencies per Title 22 Division 6 of the California Code of Regulations are detailed in the attached form LIC9099-D.

An exit interview was conducted with the facility representative and a copy of this report along with appeal rights were left at the facility.

This report was amended to correct a technical error regarding the visit type. This was a complaint visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20211221095941

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HERITAGE POINTE	FACILITY NUMBER: 300607488
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/18/2023 Section Cited CCR 87464(f)	1 2 3 4 5 6 7	The California Code of Regulations Section 87464(f) on Basic Services states that: “Basic services shall at a minimum include care and supervision [meaning] the facility assumes responsibility for (...) ongoing assistance with activities of daily living without which the resident’s physical health(...) would be endangered.	1 2 3 4 5 6 7	Facility staff is to audit the medical assessments for all residents not currently on Medication Management to verify that no other residents should have been transitioned at this time, and, if applicable, transition the residents in question before the plan of corrections due date.
	8 9 10 11 12 13 14	Assistance includes (...) taking medication” This requirement is not met as evidenced by records reviewed at the facility and interviews conducted with staff confirmed that resident R1 was left out of Medication Management for 16 months after being assessed to require assistance with self-administration.	8 9 10 11 12 13 14
Type B 02/18/2023 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	The California Code of Regulations Section 87465(a)(4) on Incidental Medical and Dental Care states that: “The licensee shall assist residents with self-administered medications as needed.”	1 2 3 4 5 6 7	Facility staff is to audit the medical assessments for all residents not currently on Medication Management to verify that no other residents should have been transitioned at this time, and, if applicable, transition the residents in question before the plan of corrections due date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by the delay observed in the implementation of the resident’s transition into Medication Management.	8 9 10 11 12 13 14

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: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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