300607488-11-28-2023-22-AS-AORZ-CY2UXU-20231129145856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 11/28/2023
Date Signed: 11/28/2023 04:12:47 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
05/31/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220531121519

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: 122	DATE:	11/28/2023
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Georgianna Mendez, Chief Executive Officer		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff left resident in soiled clothing for an extended period of time causing a rash.

Resident not administered medication as prescribed.

Staff does not provide adequate food service for residents.

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.

An initial complaint investigation visit was conducted on June 6, 2022. LPA reviewed records for four residents in care and conducted staff and resident interviews were also conducted. LPA additionally reviewed menus and requested a report of the call system activations.

During the present follow-up visit, LPA requested and obtained the facility's resident census as well as the lists of residents on medication management, receiving incontinence supplies from the facility as well as the tray service records for the week leading to the present visit.
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: 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)

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Control Number 22-AS-20220531121519

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
LPA then attempted or conducted resident interviews with six randomly selected residents who are both indicated to be on Medication Management and receiving incontinence supplies from the facility directly. Additional resident interviews had been conducted during prior facility visits investigating other complaints filed against the facility.

Regarding the allegation that Staff left resident in soiled clothing for an extended period of time causing a rash, the following has been concluded: Evidence gathered through record reviewed and interviews conducted was insufficient to corroborate that any individual residents were left in soiled clothing with obtaining timely assistance from staff.

Regarding the allegation Resident not administered medication as prescribed, the following has been concluded: Based on a review of electronic medication administration records as well as multiple interviews with residents on Medication Management conducted on November 11, 2022 and November 28, 2023, no specific instance of residents identified as requiring medication assistance per their assessment not receiving their medication in accordance to the prescription orders on file with the facility.

Regarding the allegation that Staff does not provide adequate food service for residents, the following has been concluded: Based on interviews conducted with residents and staff, no evidence of meals not being provided was found. LPA was able to verify the facility's system established to keep track of specific tray service requests and observed that all meals on the dates reviewed were accounted for. Additionally, no complaints regarding food not being served altogether were made during the resident interviews conducted.

As a result, all three allegations listed above are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

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: 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)

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