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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 05/12/2022
Date Signed: 05/12/2022 01:18:11 PM

Unfounded


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
12/27/2021 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211227105738
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: 143DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Mike Silverman, Eexecutive Director and Tiffany Kennebraw, Nursing SupervisorTIME COMPLETED:
01:17 PM
ALLEGATION(S):
1
2
3
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5
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9
-Staff do not bathe residents regularly
INVESTIGATION FINDINGS:
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2
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5
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12
13
 On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz made an unannounced complaint visit to conduct a facility inspection tour and conduct pertinent interviews in regards to allegation listed above. LPA Quiroz was greeted, COVID-19 screened and granted entry by Front Desk Concierge. LPA Quiroz met with Executive Director Mike Silverman and Nursing Supervisor Tiffany Kennebraw and explained the reason for the visit.
During the course of the investigation, LPA Quiroz conducted facility tour and interviews on January 6, 2022 and follow up tour on today's date, interviewed ten (10) interviewees and obtained the following pertinent documentation: Resident roster, staff schedules, Resident shower schedules, physician reports for Resident 1, Resident 2, Resident 3, Resident 4 and Resident 5 and Facility Family Meeting Flyer scheduled for May 18, 2022 at 4:00pm at Heritage Pointe Synagogue. Regarding the allegation "Staff do not bathe residents regularly," the investigation revealed the following: 10 of 10 interviewees denied allegation indicating residents to be receiving their baths regularly.
CONTINUED ON 9099C NEXT PAGE...
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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-20211227105738
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: 05/12/2022
NARRATIVE
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Therefore the allegation listed above is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

This report was reviewed with Executive Director Mike Silverman and and a copy of this report was provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2