374603778-7-16-2024-08-AS-SJAB-D7MP7L-20240729110406

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603778
Report Date: 07/16/2024
Date Signed: 07/16/2024 02:10:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
07/09/2024 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20240709113951

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:	07/16/2024
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Resident Service Director Nae Brownell		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Lack of supervision resulted in resident on resident altercations

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Iby Strong and Ryan Fulton conducted an unannounced visit to initiate a complaint investigation. LPAs identified themselves and discussed the purpose of the visit with Resident Services Director Nae Brownell.

On July, 9, 2024, Community Care Licensing (CCL) received a complaint alleging staff lack of supervision resulted in resident on resident altercations.

During investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. Based on Resident 1 (R1) Physician’s Report dated April 2, 2024, R1 can communicate need and can follow instructions. According to allegations, on two separate occasions, residents were not supervised resulting in R1 being hit by Resident 2 (R2) causing R1 a minor injury then and on a separate occasion R1 was scratched by Resident 3 (R3).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

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-20240709113951

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HERITAGE HILLS	FACILITY NUMBER: 374603778
	VISIT DATE: 07/16/2024

NARRATIVE

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Continuation from LIC9099

According to staff present on date of first incident, July 5, 2024, R2 was having a behavior and injured R1 causing a minor bruise to the shoulder. Staff revealed they observed the incident and provided care for R1. Staff also revealed that on another date, July 7, 2024, R3 became upset at R1, resulting in R3 scratching at R1. Staff revealed that R1 received first aid and residents were separated immediately. According to interviews, staff observed both incidents. Interview with outside sources revealed that staff acts quickly in urgent events, and there is no issue with the supervision provided to the residents in care. Lastly, records reviewed revealed facility documented events properly and have also addressed R2 and R3’s behaviors to prevent future instances. During investigation, there was no corroborating information found to determine lack of supervision resulted in resident-on-resident altercations.

Based on LPA's interviews with staff, outside source interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Resident Services Director Nae Brownell, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

LIC9099 (FAS) - (06/04)

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