374603778-2-28-2024-08-AS-SJAB-D2X34X-20240229165552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603778
Report Date: 02/28/2024
Date Signed: 02/28/2024 03:20:16 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
02/27/2024 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20240227093832

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:	02:01 PM
MET WITH:	Stefanie Ancheta, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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-Staff did not ensure resident was provided with adequate bed linens
-Staff did not adequately assist resident with activities of daily living
-Staff did not inform resident's physician of a change in resident's condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Pena conducted a visit to the facility to initiate a complaint investigation. After identifying himself and providing the purpose of the visit, LPA was allowed into the facility where he was met by Administrator, Stefanie Ancheta. Upon the conclusion of the visit, LPA provided Ms. Ancheta with investigative findings.

On 02/27/2024, the Department received this complaint which alleges; Staff did not ensure resident was provided with adequate bed linens; Staff did not adequately assist resident with activities of daily living; and Staff did not inform resident's physician of a change in resident's condition. The Department's investigation consisted of facility inspection, LPA observation, record reviews and interviews with staff and outside sources.

LPA, accompanied by Ms. Ancheta, toured the facility's memory care unit. LPA observed that each of the resident's bed obsereved had linens which appeared clean and without foul odor. LPA observed the facility's supply

Unsubstantiated

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-20240227093832

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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area and noted fresh linen in adequate numbers to provide residents with bedding. Based upon LPA observation, there was no evidence observed to support the allegation that the facility did not provide residents with adequate bed linens.

LPA reviewed Resident 1 (R1)'s records as part of this investigation. LPA observed that R1 has Alzheimer’s and Dementia diagnoses. According to R1's appraisal and physician reports, R1 requires assistance with bathing, hair care, personal hygiene, medications, observation for wandering, cash resources and activity programs. Interviews and record reviews did not provide support that R1 did not receive assistance with the aforementioned Activities of Daily Living (ADL).

LPA reviewed R1's appraisals and progress notes prepared by R1's primary care physician. LPA also reviewed R1's medication list and changes ordered by R1's primary care physician. Records provide consistent documentation that R1's physician noted no concerns with care provided by facility staff. R1's medication records did reflect changes in R1’s condition and medications were ordered to address them.

The Department has investigated the allegations as mentioned above. Based on LPA observation, record reviews and interviews the investigation failed to produce sufficient evidence to corroborate the allegations. The preponderance of evidence standard was not met; therefore, the allegations are Unsubstantiated.
An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Ms. Ancheta, whose signature below confirms receipt of these rights.

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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