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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 03/14/2023
Date Signed: 03/14/2023 05:07:55 PM

Unsubstantiated


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
01/19/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230119141500
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: 128DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Georgianna Mendez, AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility is not providing services pursuant to contract
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegation listed above and deliver findings to the licensee. LPA was greeted and granted entry by Georgianna Mendez, Administrator, after explaining the purpose of the visit and stating the allegation.

On January 27, 2023, LPA conducted an initial complaint investigation visit at the facility. Resident records for resident R1 were requested and reviewed. Interviews were conducted with resident R1 and administrator.

During the March 14, 2023 follow up visit, LPA conducted interviews with multiple members of staff as well as with administrator in order to gather additional information and updates into the failure to pay facility fees. LPA provided consultation on a potential eviction to Administrator. The facility updated staff roster was also requested during the visit, along with care assignments and care reports involving resident R1.
CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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-20230119141500
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: 03/14/2023
NARRATIVE
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CONTINUED FROM FORM LIC9099

Regarding the allegation that Facility is not providing services pursuant to contract, the following has been concluded:

Resident R1 was admitted to the facility on September 28, 2021. Following issues involving the resident's Long Term Care Insurance claim, payment of the resident's accrued facility fees ceased in 2022, causing the former facility administrator to issue a 30-day eviction notice on September 15, 2022. Facility has not followed up with filing an unlawful detainer at this point. Following the continued accrual of late fees, facility took the decision to discontinue optional services provided at additional charges to the base service rate, i.e. providing room service for meals as well as staff-provided laundry service.

At the time of the follow-up visit, past due fees are stated to be in the amount of $26,094.96. The Long Term Care insurance claim for resident R1 had to be filed again after her Needs Assessment reevaluated the resident as requireing assistance with two Activities of Daily Living. However concerns with the ability of the resident to follow up with the claim remain.

However, interviews with the resident as well as four staff members, along with a review of records conducted during the two unannounced facility visits confirmed that all other services indicated in the basic service rate in the resident's signed agreement are still being provided to resident R1 as contractually indicated in the resident's admission agreement, reviewed during the investigation.

Therefore, the allegation that Facility is not providing services pursuant to contract is deemed to be Unsubstantiated, meaning that although the allegation may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation occurred as reported.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
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