374603778-4-25-2023-08-AS-LTEZ-CRC44W-20230428184702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603778
Report Date: 04/25/2023
Date Signed: 04/25/2023 03:09:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/27/2023 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20230327094641

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: 68	DATE:	04/25/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Executive Director Stefanie Ancheta		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Facility staff did not observe resident's change in condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Stefanie Ancheta.

During today's visit, LPA conducted interviews with staff and the Executive Director.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that facility staff did not observe a resident’s change in condition specifically regarding a resident fall. Interviews and record review revealed that Resident 1 (R1) was non-ambulatory, used a wheelchair, was unable to independently transfer, and was determined to be a fall risk.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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-20230327094641

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 04/25/2023

NARRATIVE

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Interviews revealed that facility staff would attempt to keep residents who were identified as fall risks in the common areas under staff observation during the day and would conduct safety checks every 30 minutes to 1 hour if residents who were fall risks were in their rooms alone. Interviews revealed that R1 would often attempt to get up from a wheelchair or the bed without staff assistance and would fall. Interviews revealed that R1 had a roommate who would open the door to their shared room and R1 would enter the room and would often fall. Interviews and records review revealed that R1 had a fall in January 2023. Interviews revealed that staff heard R1 calling for help and found R1 on the floor and R1 stated that they had been on the floor for about 30 minutes before staff assessed R1. Interviews revealed that R1 complained about pain and the nurse was called to assess R1 and R1 was not observed to have any injuries. The staff contacted 911 who came to assess R1 for any injuries and R1 refused to go to the hospital. Interviews revealed that R1 was kept in the common areas during the rest of the day.

The Department has investigated the above-mentioned allegation and based on interviews and record review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Executive Director Stefanie Ancheta, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC9099 (FAS) - (06/04)

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