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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603778
Report Date: 11/01/2019
Date Signed: 10/11/2021 04:49:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:HERITAGE HILLSFACILITY NUMBER:
374603778
ADMINISTRATOR:KIM, LORIFACILITY TYPE:
740
ADDRESS:2108 EL CAMINO REALTELEPHONE:
(760) 385-8100
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:64CENSUS: 63DATE:
11/01/2019
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Cindy Niedrich, Resident Services DirectorTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Denise Powell conducted an unannounced Required One Year visit to ensure substantial compliance with Title 22 regulations. The facility is licensed for sixty-four elderly residents, all of whom may be non-ambulatory with an approved hospice waiver for fifteen residents (waiver increase approved, confirmation letter pending). Bedridden fire clearance is currently approved for ten residents. There are fifteen residents currently on hospice care. LPA was granted entry and met with Cindy Niedrich Resident Services Director (RSD), then conducted a tour of the facility, inside and outside. The facility appeared clean and in good repair, with comfortable and attractive accommodations provided. LPA observed food service and group activity and saw residents in care being treated with dignity by staff. Adequate caregivers were on duty to meet residents needs. All indoor and outdoor passageways were free from obstruction. The facility is operating in accordance to their fire clearance. Carbon monoxide and smoke detectors are hard wired and operable. A comfortable temperature of 74 degrees was maintained. Hot water temperature in resident bathrooms was measured at 114.9 degrees F. Each toilet and shower has grab bars for resident use and non-skid surfacing. Resident rooms have sufficient lighting. Food supplies were appropriately covered and labeled and menus were on hand. Medication is centrally stored and secured in locked medication rooms located on each floor. Staff records were reviewed and indicated current first aid/CPR training along with other required training. Review of a sample of resident records indicates that in each file, there is a current medical assessment, needs and services plan, appraisal and a signed, dated Admission Agreement. Minor deficiencies were observed in areas inspected during today's visit and are noted on the attached 809-D form. LPA provided additional guidance on emergency disaster planning, designated smoking area and advertising requirements. Administrator will submit updated LIC500 and LIC610E forms within ten days. An exit interview was conducted, plans of correction were reviewed and a copy of this report along with licensee rights was provided to RSD Cindy Niedrich whose signature below confirms receipt of these rights.
THIS IS AN AMENDED REPORT, dated 10/11/21. The Type B deficiency for 87468.2 (Personal Rights) as noted on 809-D form has been dismissed upon appeal.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HERITAGE HILLS
FACILITY NUMBER: 374603778
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
CCR
87468.2
Personal Rights of All Residents--Residents have the right to reasonable privacy in accommodations.

This requirement is not met as evidenced by: observation of resident doors are being kept locked during day, preventing reasonable access and privacy.
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above for all residents which poses a potential personal rights risk to persons in care.
POC Due Date: 12/06/2019
Plan of Correction
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Licensee stated they will conduct staff training on personal rights including alternative strategies to address wandering and related concerns. Will submit copy of completed training materials, agenda, sign ins by POC date.
Type B
Section Cited
CCR
87555(26)

Food Service Requirements--Seven day supply of non-perishable and two day supply of perishable foods shall be kept on the premises.
This requirement is not met as evidenced by: observation of inadequate perishable food items on hand. Pantry was sparse, with empty shelves and very few fresh items noted that would meet planned menu options as per weekly menu lists.
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in which poses a potential safety risk to all persons in care.
POC Due Date: 12/06/2019
Plan of Correction
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Licensee will review current food ordering and delivery systems and procedures to ensure adequate fresh food supplies are maintained on site. Will submit copy of food ordering and delivery procedures by POC date as verification.
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: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2019
LIC809 (FAS) - (06/04)
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