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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 04/09/2025
Date Signed: 04/09/2025 03:32:29 PM

Substantiated


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
04/02/2025 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250402151546
FACILITY NAME:HERITAGE POINTEFACILITY NUMBER:
300607488
ADMINISTRATOR:JONATHAN PERLESFACILITY TYPE:
740
ADDRESS:27356 BELLOGENTETELEPHONE:
(949) 364-9685
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:225CENSUS: 118DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Erin PalposiTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff did not ensure medications were dispensed as prescribed
Staff did not ensure resident records were properly managed
Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegations mentioned above. LPA met with Executive Director (ED) Erin Palposi.

Regarding allegation Staff did not ensure medications were dispensed as prescribed, the following was revealed: During the course of the investigation, LPA reviewed Medication Administrator Records (MARs) for select residents and interviewed four staff. LPA observed discrepancies in six of nine resident records. A review of Resident 1’s (R1’s) prescribed medication indicated six routine medications were not administered on March 29th, 30th, and 31st of 2025, as they were still present in the prescribed bubble pack issued by the pharmacy. Upon review of MAR, it was observed it had not been signed by staff to indicate why it had not been administered or otherwise. A review of R2’s medication indicated one routine medication was not administered on March 29th, 2025, as it was still present in the prescribed bubble pack issued by the pharmacy. Upon review of MAR, it was observed it had not been signed by staff to indicate why it had not been administered or otherwise. (Cont. LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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
Control Number 22-AS-20250402151546
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: 04/09/2025
NARRATIVE
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A review of R3’s prescribed medication revealed two routine medications for April 10th and 11th of 2025 were no longer present in the prescription bubble pack issued by the pharmacy. During their interview, S1 stated they were aware the medication for the two days was missing, but stated they were unsure of how the discrepancy occurred. Three additional staff interviewed denied any knowledge of the missing medication. A review of R4’s prescribed medication indicated two routine medications for April 10th and 11th of 2025 were no longer present in the prescribed bubble pack issued by the pharmacy. During their interview, S1 stated they were aware the medication for the two days was missing, but stated they were unsure of how the discrepancy occurred. Three additional staff interviewed denied any knowledge of the missing medication. A review of R5’s medication indicated three routine medications were not administered on March 30th, 2025, as they were still present in the prescription bubble pack issued by the pharmacy. Upon review of MAR, it was observed it had not been signed by staff to indicate why it had not been administered or otherwise. A review of R6’s medication indicated one routine medication was not administered on March 23rd, 24th, and 29th of 2025, as it was still present in the prescribed bubble pack issued by the pharmacy. Upon review of MAR, it was observed it had been signed by staff to indicate it had been administered despite it still being present in the prescription bubble pack.

Regarding allegation Staff did not ensure resident records were properly managed, the following was reviewed: Upon review of MARs for select residents, LPA observed discrepancies in four of nine resident records. Upon review of R1’s MAR, it was observed it had not been signed by staff on March 29th, 30th, and 31st of 2025 to indicate why six routine medications had not been administered or otherwise. Upon review of R2’s MAR, it was observed it had not been signed by staff on March 29th, 2025 to indicate why one routine had not been administered or otherwise. Upon review of R5’s MAR, it was observed it had not been signed by staff on March 30th, 2025 to indicate why three routine had not been administered or otherwise. Upon review of R6’s MAR, it was observed one routine medication had been signed by staff on March 23rd, 24th, and 29th of 2025 to indicate it had been administered despite it still being present in the prescription bubble pack.

Regarding allegation Staff did not ensure reporting requirements were followed: LPA conducted a record review of Incident Reports (LIC624) submitted by the facility to Community Care Licensing (CCL) and did not observe any incidents reports for the medication errors listed above. During today’s visit, LPA was provided with an incident report for medication errors. (Cont. LIC9099-C)
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20250402151546
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: 04/09/2025
NARRATIVE
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Based on staff interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end today's inspection.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20250402151546
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2025
Section Cited
HSC
1569.2(c)
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"Care and supervision" means the facility assumes responsibility for... ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety or welfare would be endangered.
This requirement is not met as evidenced by:
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ED stated staff training on medication management will be conducted and a copy provided to LPA with proof via email by POC date.
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Based on staff interviews and records review, the licensee did not comply with the section cited above as residents' medications are not being dispensed as prescribed, which poses an immediate health, safety, and personal rights risk to persons 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: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250402151546
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/23/2025
Section Cited
CCR
87506(a)
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(a) The licensee shall ensure that a separate, complete, and current record is maintained...

This requirement is not met as evidenced by:

Based on record review, the licensee did not comply with the section cited above as four
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ED stated residents' MARs will be updated to reflect correct information regarding medication administration and copy provided to LPA via email by POC date.
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of nine resident MARs were observed to be incomplete, which poses a potential health, safety, and personal rights risk to persons in care.
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Type B
04/23/2025
Section Cited
CCR
87211(a)(1)
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(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence...

This requirement is not met as evidenced by:
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ED stated they will provide LPA with a written plan of action to ensure compliance with regulation via email by POC date.
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Based on record review, the licensee did not comply with the section cited above as an incident report was not submitted within seven days following a medication error which poses a potential health, safety, and personal rights risk to persons 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: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5