374603778-11-6-2023-08-AS-LTEZ-CXYTRN-20231127135748

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603778
Report Date: 11/06/2023
Date Signed: 11/06/2023 04:47:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/04/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230404114645

FACILITY NAME:	HERITAGE HILLS		FACILITY NUMBER:	374603778
ADMINISTRATOR:	STEFANIE ANCHETA		FACILITY TYPE:	740
ADDRESS:	2108 EL CAMINO REAL		TELEPHONE:	(760) 206-7930
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92054
CAPACITY:	74	CENSUS: 70	DATE:	11/06/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Executive Director Stefanie Ancheta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility did not administer medication to resident, as prescribed.
Lack of supervision resulted in resident elopement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Executive Director Stefanie Ancheta.

On 4/4/23 it was alleged that the facility did not administer medication to a resident as prescribed, and that lack of supervision resulted in a residents' elopement. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, and outside sources.

Regarding the allegation, "Facility did not administer medication to a resident, as prescribed", it was alleged that a resident (R1) received a pro re nata (PRN) medication too soon within the prescription orders, and did not receive a medication after the facility received it. Staff interview and records review revealed that R1 received the PRN within the required timeframes on the day in question.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

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 08-AS-20230404114645

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HERITAGE HILLS	FACILITY NUMBER: 374603778
	VISIT DATE: 11/06/2023

NARRATIVE

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(Continued from LIC9099)

Staff interview further revealed that there had been ongoing confusion and communication issues between the facility and pharmacy, resulting in instances where it was unknown if a medication had been sent out, received, or should be administered. Outside interviews corroborated the communication issues, informing that the outside agency and the facility were in communication to correct the issues. No records reviewed corroborated that staff administered medication outside of R1's prescription.

Regarding the allegation, "Lack of supervision resulted in resident elopement", it was alleged that a resident eloped from the facility due to staff not providing adequate supervision. Staff interview showed that internal investigation of the incident was conducted, revealing that multiple delayed egress doors could be deactivated at the same time. This issue resulted in a resident exiting from the opposite side of the building while staff were addressing a different resident who had pushed the delayed egress door. Resident interview corroborated that the resident was able to exit through a different door during the same time the delayed egress door was pushed on the opposite side of the building. Records review revealed that staff Outside sources interviewed stated that the facility had supervision concerns during the timeframe of the complaint allegation; however, no interviews or records corroborated that there was a lack of supervision at the time of the incident. Records review, corroborated by staff interview, revealed that staff responded immediately to the delayed egress door and located the resident who had activated it. Based on the evidence gathered, the cause of the elopement was due to the unknowingly linked door system; no evidence was found to support that the elopement was due to lack of supervision. Case Management was provided with the Licensee regarding correcting the door system issue.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Executive Director Stefanie Ancheta, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC9099 (FAS) - (06/04)

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