300607488-1-31-2025-22-AS-AORZ-DFMSZ8-20250411141840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 01/31/2025
Date Signed: 01/31/2025 03:07:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/02/2021 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20210302151348

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: 109	DATE:	01/31/2025
		UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Erin Palposi		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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The facility staff did not check on resident to turn regularly resulting in deep tissue wound on leg
The facility staff handled the resident in a rough manner
The facility failed to provide food for the resident in a timely manner
The resident was not given medications as prescribed
The resident was not receiving laundry services as agreed
The resident was found saturated in urine and feces on multiple occasions due to facility not providing incontinent care
The facility did not send the correct health agent's information to the hospital with the resident resulting in the resident's health agent not being informed of the situation or make decisions on resident's behalf

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced complaint visit to continue to the investigation into the above allegations. LPAs were greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff and residents as well as reviewed and obtained pertinent documentation such as facility notes. Regarding the allegations that facility staff did not check on resident to turn regularly resulting in deep tissue wound on leg, the facility staff handled the resident in a rough manner, the facility failed to provide food for the resident in a timely manner, the resident was not given medications as prescribed, the resident was not receiving laundry services as agreed, the resident was found saturated in urine and feces on multiple occasions due to facility not providing incontinent care and the facility did not send the correct health agent's information to the hospital with the resident resulting in the resident's health agent not being informed of the situation or make decisions on resident's behalf, the investigation revealed the following: Resident 1 (R1) was diagnosed with stage 4 ovarian cancer. CONTINUED ON LIC 9099C DATED 01/31/2025

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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-20210302151348

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HERITAGE POINTE	FACILITY NUMBER: 300607488
	VISIT DATE: 01/31/2025

NARRATIVE

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Facility nurse's notes indicate resident was admitted to hospice care 01/18/2021 and started receiving wound care daily on 02/07/2021 until end of life 02/22/2021. Three out of three staff state resident was being repositioned every 2 hours due to the wound. Resident started receiving the fentanyl patch effective 02/05/2021. Facility notes indicate resident was receiving the patch by hospice nurse. Facility staff state resident was receiving meals delivered to the resident's room due to covid pre-cautions and all residents received meals. Facility does not have copies of meal checklists from 2021. Interview with housekeeper familiar with resident indicated all laundry services were performed for the resident. Three out of three staff state incontinence care is provided every 2 hours and deny resident was left soiled. All staff interviewed state resident's needs were being met and all deny any staff being rough with any resident. Five out of five residents state satisfaction with facility and indicate staff is good to them. Facility does not have Durable Power of Attorney (DPOA) paperwork on file however R1's face sheet designates a DPOA and a medical proxy to two different individuals. Based on interviews conducted and records reviewed, LPA is unable to corroborate the allegations. Therefore the allegations are deemed UNSUBSTANTIATED, meaning although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur. Exit interview conducted and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC9099 (FAS) - (06/04)

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