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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 07/22/2025
Date Signed: 07/22/2025 04:19:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2022 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220209101001
FACILITY NAME:HERITAGE POINTEFACILITY NUMBER:
300607488
ADMINISTRATOR:MIKE SILVERMANFACILITY TYPE:
740
ADDRESS:27356 BELLOGENTETELEPHONE:
(949) 364-9685
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:225CENSUS: 107DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Erin PATIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff are not providing adequate care and supervision to the residents

Staff did not accord resident's with dignity
INVESTIGATION FINDINGS:
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7
8
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10
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13
On July 22, 2025, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the four allegations listed above. LPA was greeted and granted entry by Executive Director Erin Palposi after explaining the purpose of the visit.

The initial complaint investigation visit was conducted on February 17, 2022. During thre visit, LPA requested and obtained the resident care plan and admission agreement for resident R1, as well as the staff work schedules for the week of 01/24/2022 to 01/30/2022. Copies of the shift reports have also been obtained along for the period being investigated. A resident interview with R1 was also conducted.

A follow-up visit took place on April 21, 2022. LPA was able to obtain documentation of attendance for the most recent all-staff meeting during which pendant activation training was provided during the facility updates, as well as the complete log for all pendant pushes and pull-cord activations in the facility along with location and response time. CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2022 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220209101001

FACILITY NAME:HERITAGE POINTEFACILITY NUMBER:
300607488
ADMINISTRATOR:MIKE SILVERMANFACILITY TYPE:
740
ADDRESS:27356 BELLOGENTETELEPHONE:
(949) 364-9685
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:225CENSUS: 107DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Erin Palposi, TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to ensure oxygen tanks were in working order
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 22, 2025, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the four allegations listed above. LPA was greeted and granted entry by Executive Director Erin Palposi after explaining the purpose of the visit.

The initial complaint investigation visit was conducted on February 17, 2022. During thre visit, LPA requested and obtained the resident care plan and admission agreement for resident R1, as well as the staff work schedules for the week of 01/24/2022 to 01/30/2022. Copies of the shift reports have also been obtained along for the period being investigated. A resident interview with R1 was also conducted.

A follow-up visit took place on April 21, 2022. LPA was able to obtain documentation of attendance for the most recent all-staff meeting during which pendant activation training was provided during the facility updates, as well as the complete log for all pendant pushes and pull-cord activations in the facility along with location and response time. CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20220209101001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HERITAGE POINTE
FACILITY NUMBER: 300607488
VISIT DATE: 07/22/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-A
Additional witness interviews were conducted during the investigation.

Regarding the allegation that Facility failed to ensure oxygen tanks were in working order, the following has been concluded: Witness and resident interviews conducted evidenced that the equipment used by R1 for supplemental oxygen was functioning correctly. However, due to poor vision documented in R1's assessment and evidenced in interviews, R1 would occasionally require staff assistance to operate her small oxygen tank, with occasional excessive waiting times. Issues with oxygen seem to have been solved by the provision of a concentrator.

Based on the evidence gathered, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of this report was provided to facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2022 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220209101001

FACILITY NAME:HERITAGE POINTEFACILITY NUMBER:
300607488
ADMINISTRATOR:MIKE SILVERMANFACILITY TYPE:
740
ADDRESS:27356 BELLOGENTETELEPHONE:
(949) 364-9685
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:225CENSUS: 107DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Erin Palposi, Executive DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents alerts are not operating while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 22, 2025, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the four allegations listed above. LPA was greeted and granted entry by Executive Director Erin Palposi after explaining the purpose of the visit.

The initial complaint investigation visit was conducted on February 17, 2022. During thre visit, LPA requested and obtained the resident care plan and admission agreement for resident R1, as well as the staff work schedules for the week of 01/24/2022 to 01/30/2022. Copies of the shift reports have also been obtained along for the period being investigated. A resident interview with R1 was also conducted.

A follow-up visit took place on April 21, 2022. LPA was able to obtain documentation of attendance for the most recent all-staff meeting during which pendant activation training was provided during the facility updates, as well as the complete log for all pendant pushes and pull-cord activations in the facility along with location and response time. CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 22-AS-20220209101001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HERITAGE POINTE
FACILITY NUMBER: 300607488
VISIT DATE: 07/22/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-A
Additional witness interviews were conducted during the investigation.

Regarding the allegation that Residents alerts are not operating while in care, the following has been concluded: Licensing staff conducted multiple visits during which the facility's call system was observed to be in operation. Staff and resident interviews conducted during the investigation did not evidence any period of time during which the call system was not in operation. Additionally, the vendor for the facility provided records of all pendant and pull cords activations for the period of January 2022 corresponding to the allegation being made. A review of the records provided confirmed the statements made indicating an absence of technical issues with the call system.

As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 22-AS-20220209101001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HERITAGE POINTE
FACILITY NUMBER: 300607488
VISIT DATE: 07/22/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099
Additional witness interviews were conducted during the investigation.

Regarding the allegation that Staff are not providing adequate care and supervision to the residents, the following has been concluded: Based on interviews conducted and records reviewed, it was confirmed that on January 28, 2022 at approximately 10:30pm, staff was alerted by another resident's family of an ongoing episode.
Staff notes from facility LVN Tiffany Kennebrew are reviewed as follows "Care staff and another resident's family reported that resident was yelling out in hallway. Nurse on duty checked on resident and noted that the resident had increased agitation and oxygen level was below 90%. 911 called to evaluate resident. EMT's reported that resident was having [signs and symptoms] of panic attack [due to] not being able to work portable oxygen machine. Resident refused hospital transport and EMT's educated resident on how to properly work machine. [Daughter] Sherri notified and this nurse asked [daughter] to look into getting a concentrator for ease of use of oxygen therapy". Due to the resident's assessed vision issues and response delay, facility staff appears to have failed to meet the requirement to ensure the resident could safely operate their oxygen equipment.

Regarding the allegation that Staff did not accord resident's with dignity, the following has been concluded: A review of the facility's records for pendant pushes on January 28, 2022 demonstrates that the initial activation made by R1 is timestamped as follows: "1/28/2022 21:49 [...] Alpers, Helene (lives in Apt 255) 244-2033 from Receiver by 154, [...] Announced 9 times. Healthcare Wristlet 150CD responded at 10:32 p (43 mins)." As R1 was experiencing difficulty in operating their oxygen equipment, R1 had to wait 43 minutes to receive assistance from staff and was observed being agitated in the hallway.

As a result, both allegations are found to be Substantiated, meaning that the preponderance of evidence standard has been met.

An exit interview was conducted and a copy of this report along with appeal rights was provided and left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20220209101001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HERITAGE POINTE
FACILITY NUMBER: 300607488
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2025
Section Cited
CCR
87618(b)(1)
1
2
3
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5
6
7
Per CCR Section 87618(b)(1) on Oxygen Administration: "the licensee shall be responsible for the following: Monitoring of the resident's ongoing ability to operate the equipment in accordance with the physician's orders". This requirement was not met as evidenced by:
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Licensee to audit residents using oxygen equipment to ensure their ability to operate in accordance to physician orders. Proof of review to be submitted before the plan of corrections due date.
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Based on interviews and record reviews, facility staff did not monitor R1's ability to operate their oxygen equipment and failed to provide timely assistance. This constitutes a potential risk to the health, safety and personal rights of residents in care,
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Type B
07/31/2025
Section Cited
CCR
87464(f)(1)
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7
Per CCR 878464(f)(1) on Basic Services: "Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c)". This requirement is not met as evidenced by:
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Licensee received a similar citation for more recent instances of the same allegations. Current corrections will be reviewed in order to clear this additional deficiency based on older circumstances.
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Based on records reviewed and interviews conducted, instances of excessive response times were recorded for resident R1 over the reviewed period of January 2022.This constitutes a potential risk to the health, safety and personal rights of individuals 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.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7