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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 11/02/2023
Date Signed: 11/14/2023 04:47:21 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
09/11/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230911152506
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: 126DATE:
11/02/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tami Olsen, Executive AssistantTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not ensuring that hazardous items are inaccessible to residents in care.
Staff are not ensuring that residents have diapering products.
Staff are not following medication orders.
Facility is not ensuring that an accurate staffing schedule is being posted.
Staff did not administer medication to residents in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 five allegations listed above. LPA was greeted and granted entry by facility staff after explaining the reason for the visit.

LPA requested and obtained the facility full resident census as well as the list of residents currently on Medication Management and the list of residents being billed for incontinence supplies for the months of September and October 2023. Medication Administration Records for Memory Care unit residents R1, R2, R3 and R4 were requested and obtained for the months of September and October 2023. Daily Care Staff assignments for September and October 2023 were also provided. Printouts of email exchanges with the families providing incontinence supplies directly were added to the investigation file.

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: 11/02/2023
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20230911152506
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: 11/02/2023
NARRATIVE
1
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3
4
5
6
7
8
9
10
11
12
13
14
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20
21
22
23
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32
CONTINUED FROM FORM LIC9099 - A total of five memory care unit resident interviews and five staff interviews were either attempted or conducted during the visit.
Regarding the allegation that Staff are not ensuring that hazardous items are inaccessible to residents in care, the following has been concluded: Based on observations made during two separate visits of the memory care unit in addition to staff interviews, it was determined that sharps and toxics were being locked away when not in use. Observations were conducted while care staff was in attendance serving meals.

Regarding the allegation that Staff are not ensuring that residents have diapering products, the following has been concluded: Based on interviews, record reviewed and observation made in the memory care unit, it was determined that memory care unit residents could either be provided incontinence supply by the facility, by their families or by hospice services depending on their personal situation and preferences. In each case, measures are in place to prevent staff running out. However, occasional supply issues having to be supplemented were also described with some of the residents admitted on hospice with a specific provider due to practices of one specific hospice staff. It was however not evidenced that residents were ever found in a situation were their incontinence needs could not be addressed altogether.

Regarding the allegations that Staff are not following medication orders, and that Staff did not administer medication to residents in a timely manner, the following has been concluded: Based on interviews, observation of administration practices and a review of the Medication Administration records for four randomly selected memory care unit residents, it was found that all orders were being adequately logged in the system and resulted in documented administration. Deviations from the scheduled dispensations are also found to be documented appropriately whenever they occurred due to a resident being out or refusing to take the medication.

Regarding the allegation that Facility is not ensuring that an accurate staffing schedule is being posted, monthly schedules are observed to be posted in staff common areas and are complemented with Daily Care Assignments being filled in every day. Staff interviewed denied having had issues with call-outs not being supplemented or not knowing to which shifts they were assigned.

The five allegations are therefore found to be Unfounded, meaning that the allegations are false, could not have happened and/or are without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted and a copy of this report was 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: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2