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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 03/16/2022
Date Signed: 03/16/2022 02:25:29 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
11/25/2020 and conducted by Evaluator Rosie Quiroz
COMPLAINT CONTROL NUMBER: 22-AS-20201125133750
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: 146DATE:
03/16/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Tracii Brown, Director of HealthCareTIME COMPLETED:
09:42 AM
ALLEGATION(S):
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-Facility failed to safeguard resident’s property
INVESTIGATION FINDINGS:
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz, was greeted, COVID-19 screened and met with Director of HealthCare (DOHC) Tracii Brown for the purpose to deliver findings for a complaint investigation.
The initial 10-day visit was completed on 12/07/2020 by LPA Barrett.
During the course of this investigation, LPA Quiroz conducted interviews, reviewed documents including but not limited to Resident Personal Property and Valuables Lists, Physician Reports, Needs and Services Appraisals and Admission Agreements for 4 of 4 residents.
It was alleged that "Facility failed to safeguard resident's property." During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed Resident Personal Property and Valuables lists with interviewees. 3 of 4 interviewees denied allegation of "Facility failed to safeguard resident's property."
Both parties were reminded of importance of timely and accurate personal inventory.
CONTINUED ON NEXT PAGE...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
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-20201125133750
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: 03/16/2022
NARRATIVE
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Based on a review of the documentation, observations and interviews conducted, we have found the complaint allegation of "Facility failed to safeguard resident's property," 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.
An exit interview was conducted with (DOHC)Tracii Brown and a copy of this report was provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
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