300607488-11-17-2023-22-AS-AORZ-CXNVBW-20231117151811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 10/19/2023
Date Signed: 11/17/2023 01:25:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/11/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230911091528

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:	DATE:	10/19/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Georgianna Mendez, Chief Executive Officer		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not prevent a resident from harming another resident.

Staff did not seek timely medical attention for a resident.

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. LPA was greeted and granted entry by front desk staff before meeting Chief Executive Officer Georgianna Mendez.

An initial complaint investigation was conducted on September 14, 2023. LPA requested and obtained resident records for residents R1 and R2. Interviews were conducted with both residents during the facility visit. Additional information such as a police report reference number were also obtained during the visit. Two staff members were also interviewed during the visit.

Additional staff interviews were conducted during the present visit before delivering findings to a facility representative.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

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: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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-20230911091528

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 10/19/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Regarding the allegation that Staff did not prevent a resident from harming another resident, the following has been concluded: Various conflicting accounts of the incident reported were made during the investigation of the present complaint. The alleged confrontation occurred in a high-traffic area of the facility, however the resident making the allegations was unable to identify any outside witness who could have corroborated their account. As a result, even though it cannot be fully ruled out that some physical contact between residents R1 and R2 may have occurred, none of the evidence gathered during the investigation can confirm that it did actually occur. Facility staff can thus not be held responsible for circumstances that the Department was unable to corroborate. The allegation is therefore found 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 did occur.

Regarding the allegation that Staff did not seek timely medical attention for a resident, the following has been concluded: Based on interviews and records reviewed, it was determined that the facility had received the request from resident R1 to be transported to a primary care provider and that transportation was provided according to the facility's bus schedule established by facility staff upon expressed needs. As a result, the allegation is found the be Unsubstantiated, meaning that the preponderance of evidence standard has been met. LIC9099-D generated due to a system error.

An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.

An exit interview was conducted and a copy of this report was provided to a facility representative

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC9099 (FAS) - (06/04)

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