374603778-2-28-2024-08-AS-SJAB-D2X2W3-20240229164452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603778
Report Date: 02/28/2024
Date Signed: 02/28/2024 03:21:48 PM

Unfounded

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
02/21/2024 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20240221104203

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:	78	CENSUS: 71	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	11:17 AM
MET WITH:	Stefanie Ancheta, Administrator		TIME COMPLETED:	02:01 PM

ALLEGATION(S):

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Unlawful Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced complaint visit. LPA gained access to the facility and met with Administrator, Stefanie Ancheta and explained the purpose of the visit which was to initiate a complaint investigation. Upon conclusion of the facility visit, LPA delivered findings for the above allegation to Ms. Ancheta.

The Department’s investigation consisted of visits to the facility, resident records reviews and interviews with pertinent staff and outside sources. It was alleged Resident 1 (R1) was unlawfully evicted from the facility. Record reviews indicated that R1 had displayed aggressive behaviors towards residents and staff four times. R1’s changes in behavior were documented in appraisals, physician reports and physician progress notes. R1’s aggressive behaviors caused injury to residents. Upon move in, R1’s Power of Attorney signed the facility’s admission agreement which reads in part,

"#3 Residents must not engage in conduct that poses a danger to themselves or others at the community,

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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-20240221104203

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: 02/28/2024

NARRATIVE

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must not be disruptive, must not create unsafe conditions, and must not be physically or verbally abusive to other residents or staff."

Records reviewed provide support that R1’s behavior violated the facility’s terms which was digitally signed by R1’s POA on 11/23/2022. LPA reviewed the facility’s 30-day notice of eviction and confirmed it meets the requirements in Title 22 Regulations.

Based on records reviews and interviews with pertinent staff and outside sources, the complaint allegation is determined to be Unfounded, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, as to the above listed allegation, the facility followed Title 22 regulation at this time, and the Department has dismissed the complaint.

An exit interview was conducted with Ms. Ancheta and a copy of this report and Licensee/Appeal Rights (LIC 9058 01/16) were provided to the following the visit. Ms. Ancheta’s signature below confirms receipt of the records.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

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