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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607488
Report Date: 05/10/2022
Date Signed: 05/10/2022 10:45:37 AM


Document Has Been Signed on 05/10/2022 10:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



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: DATE:
05/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mike Silverman, Chief Executive OfficerTIME COMPLETED:
11:00 AM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced case management visit for the purpose of following up on a Special Incident Report received at the Regional Office on 05/05/2022. LPA was greeted and granted entry by Mike Silverman, Chief Executive Officer (CEO) and explained the purpose of the visit.

CEO Silverman indicates that there was an investigation conducted into checks that were written by resident R1 to the Gift Shop, Beauty Shop and to the resident's private caregiver being provided by Pioneer Home Care Agency.
Officer Zellers from the Orange County Sheriff's Department was called to investigate. An admission was obtained from Edward James in regard to a $300 check that was sent to his spouse abroad as well as other cashed checks to pay for personal expenses (gas and food). Caregiver has been reported to the Human Resources at Pioneer Home Care, and a representative from the agency made a visit to the facility. CEO Silverman also states that to his knowledge, the caregiver has been let go by the agency. Additionally, the resident's family is requesting to be refunded for the misappropriated funds and facility is currently exchanging with Pioneer Home Care on that topic.

LPA requested and obtained the OCSD case number for the report as well as R1's resident file. A Durable Power of Attorney is on file and designates the resident's daughter and son. The physician's report dated 03/28/2022 indicates that the resident has mild cognitive impairment, and states that the resident is not able to handle cash resources. OCSD case number is 22-014682. Agency staff is not associated with the facility in Guardian, but the facility's contract with the agency indicates that caregivers are required to be cleared. The only facility-specific documentation at the facility for caregiver Edward James pertains to their COVID-19 vaccination status.

An exit interview was conducted and a copy of this report was provided to the facility representative.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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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