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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 11/28/2023
Date Signed: 11/28/2023 04:10:16 PM

Unfounded


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
02/11/2022 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220211164547
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: 122DATE:
11/28/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Georgianna Mendez, Chief Executive OfficerTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility did not provide resident's records to resident's responsible party.

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 into the allegation listed above. LPA was greeted and granted entry by facility administrator Georgianna Mendez after stating the purpose of the visit and listing the allegations.

The initial complaint investigation visit was conducted on February 17, 2022. During the visit, LPA requested and obtained the resident care plan for resident R1, as well as the staff work schedules for the week of 01/24/2022 to 01/30/2022. The requested admission agreement for R1 could not be located at the time of the visit, resulting in a deficiency that was cited at the time. A follow-up visit was held on April 21, 2022 and one interview was conducted with the facility accountant at that time.

CONTINUED ON FORM LIC9099-C
Unfounded
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: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
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 5
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
02/11/2022 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220211164547

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: 122DATE:
11/28/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Georgianna Mendez, Chief Executive OfficerTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Facility overcharged 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 into the allegation listed above. LPA was greeted and granted entry by facility administrator Georgianna Mendez after stating the purpose of the visit and listing the allegations.

The initial complaint investigation visit was conducted on February 17, 2022. During the visit, LPA requested and obtained the resident care plan for resident R1, as well as the staff work schedules for the week of 01/24/2022 to 01/30/2022. The requested admission agreement for R1 could not be located at the time of the visit, resulting in a deficiency that was cited at the time. A follow-up visit was held on April 21, 2022 and one interview was conducted with the facility accountant at that time.

CONTINUED ON FORM LIC9099-C
Substantiated
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: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20220211164547
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: 11/28/2023
NARRATIVE
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CONTINUED FROM FORM LIC9099-A
Regarding the allegation that Facility overcharged resident., the following has been concluded: Based on a review of email exchanges between facility staff and R1's authorized representatives along with staff interviews and a review of R1's billing records for the period of November 2021 until February 2022, it was confirmed that additional charges for tray service were charged to the resident in spite of the ongoing policy to waive the fees in question during the occurrence of outbreaks of COVID-19 as well as during periods of illness experienced by the resident. The allegation is therefore found to be Substantiated, meaning that the preponderance of evidence standard has been met.

A Type B citation is issued on the attached form LIC9099-D

An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20220211164547
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2023
Section Cited
CCR
87507(g)(3)(B)(2)
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The California Code of Regulations Section 87507(g)(3)(B)(2) states that: "A separate charge (...) may be assessed only if that charge is included in and authorized by the admission agreement." In the absence of the agreement and due to the COVID waivers in place at the time, the separate (...)
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Licensee will re-initiate the dialogue with R1's family to resolve any potential excess paid. Proof of the discussion will be provided to LPA by the Plan of Corrections due date.
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charges for tray services should not have been assessed as observed on billing documents. This constitute a potential risk for the health, safety and personal rights of residents in care.
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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: 11/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20220211164547
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: 11/28/2023
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Facility did not provide resident's records to resident's responsible party, the following has been concluded. At the time of the follow-up visit conducted on April 21, 2022, the authorized representative for R1 had been provided with the requested documentation as confirmed by a review of written exchanges along with interviews with involved parties. Therefore the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. The complaint allegation is therefore dismissed.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5