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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607488
Report Date: 11/02/2023
Date Signed: 11/02/2023 04:10:22 PM


Document Has Been Signed on 11/02/2023 04:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:HERITAGE POINTEFACILITY NUMBER:
300607488
ADMINISTRATOR:GEORGIANNA MENDEZFACILITY TYPE:
740
ADDRESS:27356 BELLOGENTETELEPHONE:
(949) 364-9685
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:225CENSUS: 126DATE:
11/02/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tami Olsen, Executive AssistantTIME COMPLETED:
10:29 AM
NARRATIVE
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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 conducting a case management inspection. During the investigation of complaint 22-AS-20230911091528, LPA conducted a review of the resident records for resident R1 and conducted an interview with the resident.

During a visit conducted on September 14, 2023, R1 was observed to be independently managing their own medication.

However, a review of R1's resident records conducted during the investigation evidenced that the resident had been assessed to require assistance with the administration of their own prescribed medication as documented in the most recent physician report on file. Report is dated August 13, 2021. Based on staff interviews and observation made during the visit, as of the first visit conducted on September 14, 2023, the resident had not been placed under Medication Management by the facility and was still handling her own prescribed treatments autonomously without receiving the required assistance.

A type B deficiency is being cited as a result, with the assessment of an immediate civil penalty due to a repeat offence.

An exit interview was conducted and a copy of this report along with appeal rights were provided to the facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
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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Document Has Been Signed on 11/02/2023 04:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: HERITAGE POINTE

FACILITY NUMBER: 300607488

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
Section Cited
CCR
87464(f)

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The California Code of Regulations Section 87464(f) on Basic Services states that: “Basic services shall at a minimum include care and supervision [meaning] (...) responsibility for (...) ongoing assistance with ADLs without which the resident’s physical health(...) would be endangered.
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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.
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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 after being assessed to require ongoing assistance with medication.
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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 SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
LIC809 (FAS) - (06/04)
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