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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607488
Report Date: 06/06/2022
Date Signed: 06/06/2022 04:00:52 PM


Document Has Been Signed on 06/06/2022 04:00 PM - 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: 139DATE:
06/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Mike Silverman, Administrator
Tracii Brown, Director of Health Care
TIME COMPLETED:
12:00 PM
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On 06/06/2022 at 11:15am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to the facility following up on an incident report submitted to the Regional Office on 05/27/2022. LPA was greeted and granted entry by facility administrator Mike Silverman after explaining the purpose of the visit.

Administrator states that the incident occurred on a weekend and required his presence back at the facility. Agency caregiver S1 was alleged to have handled resident R1 in a rough manner, and that caregiver would not allow resident to ambulate freely from the bedroom to the bathroom without being in her wheelchair, claiming time constraints and the inability to supervise the resident adequately.

M. Silverman interviewed the contracted staff in present of a facility caregiver and additionally reported the incident to the Long Term Care Ombudsman and staffing company, Pioneer Staffing. Administrator indicates that efforts are made to hire permanent staff with 9 new caregivers being onboarded, but that at this time a large number of agency staff is still being needed to fill in with approximately three or four agency staff for every shift on a total of six to eight total caregivers present.

The Health Care Department is also making efforts to identify agency staff that are reliable and more qualified in order to prioritize their schedule over other agency staff.

LPA also consulted with Administrator to indicate that the preferred procedure to address abuse allegations was to take staff action ensuring the residents' well-being but that investigative actions was as a priority left to the licensing authority to handle.

An exit interview was conducted and a copy of this report was printed and left to facility representative.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
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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