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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603778
Report Date: 04/11/2023
Date Signed: 04/11/2023 01:13:57 PM


Document Has Been Signed on 04/11/2023 01:13 PM - It Cannot Be Edited

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:STEFANIE ANCHETAFACILITY TYPE:
740
ADDRESS:2108 EL CAMINO REALTELEPHONE:
(760) 206-7930
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:74CENSUS: 69DATE:
04/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Executive Director Stefanie AnchetaTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Stefanie Ancheta.

Today's visit was in response to the self-reported AWOL (absent without leave) of Resident #1 (R1) received in the San Diego Regional Office on 04/03/2023. [See LIC 811 Confidential Names List for a description of R1]. According to the report, R1 activated a delayed-egress exit door and then went down a stairwell and exited into the facility’s parking garage/lot. A bystander saw R1 there and alerted facility staff, who escorted R1 back to the facility. R1 was unharmed/uninjured.

During today’s visit, LPA performed a welfare check on R1, verifying that they were indeed unharmed/uninjured. LPA briefly toured the facility and observed/tested the facility’s six (6) delayed-egress exit doors. LPA also interviewed pertinent staff, provided Technical Assistance regarding best practices for elopement drills, and reviewed a relevant staff training document.

LPA observed that all six (6) of the facility’s delayed-egress exit doors featured highly visible exit signs with the required verbiage and text size, as described in California Health and Safety Code Section 1569.699(a)(7). However, for two (2) of these doors, (known as “1st Floor South” and “1st Floor North," the location of the required sign exceeded 12 inches from the panic bar or door latching hardware.

One deficiency was thus cited per California Health and Safety Code (refer to the attached LIC 809-D).

An exit interview was conducted with Ancheta, to whom a copy of this report, the LIC 809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023
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


Document Has Been Signed on 04/11/2023 01:13 PM - It Cannot Be Edited

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: 04/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/11/2023
Section Cited

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1569.699 Exit doors; egress-control devices of time-delay type; fences: (a)(7)(A) A sign shall be provided on the door located above and within 12 inches (305mm) of the panic bar or other door-latching hardware…” This requirement was not met, as evidenced by:
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Licensee agreed to add an additional signage (meeting the requirements of California Health and Safety Code Section 1569.699(a)(7)) to its “1st Floor South” and “1st Floor North” delayed-egress doors, such that they are positioned within 12 inches from the panic bar or door-latching hardware. Licensee agreed to E-mail LPA photos of such by the POC due date.
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Based on LPA observation, licensee did not place the required sign within 12 inches of the panic bar or other door-latching hardware for 2 of 6 delayed-egress exit doors, which posed a potential safety risk to persons in care.
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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: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023
LIC809 (FAS) - (06/04)
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