300607488-1-27-2026-22-AS-SSAS-DQRT2R-20260128132108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300607488
Report Date: 01/27/2026
Date Signed: 01/27/2026 04:29:54 PM

Unsubstantiated

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
02/17/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220217161044

FACILITY NAME:	HERITAGE POINTE		FACILITY NUMBER:	300607488
ADMINISTRATOR:	MIKE SILVERMAN		FACILITY TYPE:	740
ADDRESS:	27356 BELLOGENTE		TELEPHONE:	(949) 364-9685
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	225	CENSUS: 108	DATE:	01/27/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Georgianna Mendez, Executive Director		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Facility did not notify responsible party of change of condition for resident

Staff mismanaged residents medication.

Staff did not ensure resident is provided an adequate amount of water.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the five allegations listed above. LPA was greeted and granted entry by front desk after stating the purpose of the visit. Executive Director Georgianna Mendez was present on the premises and assisted with the visit after being presented with the allegations under review.

The initial complaint investigation visit was conducted on February 24, 2022. During the visit, licensing staff requested and obtained resident R1's Medication Administration Records for the months of December 2021 and January 2022 as well as R1's charting notes for the same period.

A follow-up visit took place on April 21, 2022 and involved multiple open complaints at the time. LPA conducted additional staff and resident interviews and obtained additional documentation. Hospital records for R1 were also obtained and reviewed during the investigation. CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

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 4

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
02/17/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220217161044

FACILITY NAME:	HERITAGE POINTE		FACILITY NUMBER:	300607488
ADMINISTRATOR:	MIKE SILVERMAN		FACILITY TYPE:	740
ADDRESS:	27356 BELLOGENTE		TELEPHONE:	(949) 364-9685
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	225	CENSUS: 108	DATE:	01/27/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Georgianna Mendez, Executive Director		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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9

Resident not administered medication as prescribed

Staff disposed residents medication.

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

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 4

Control Number 22-AS-20220217161044

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: 01/27/2026

NARRATIVE

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CONTINUED FROM FORM LIC9099-A
Regarding the allegation that Resident not administered medication as prescribed, the following has been concluded: Resident R1 was briefly hospitalized at Providence Mission Hospital on January 20, 2022. Per the hospital report reviewed, R1 had been seen by their primary care provider in the weeks prior and prescribed a course of antibiotics for a urinary tract infection, which is alleged to not have been provided adequately to R1 by facility staff. Per a review of R1's hospital records, it was confirmed via testing that the infection treated had been resolved at the time of the admission to the emergency department for weakness and dehydration. A review of the Medication Administration Records provided additionally corroborates the medication being dispensed adequately.

Regarding the allegation that Staff disposed residents medication, the following has been concluded: Upon R1's passing on February 8, 2022, facility staff proceeded to destroy the resident's medication as mandated by Section 87465(i) of the California Code of Regulations stating that "Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record". The record in question was provided during the investigation and added to the investigation file.

Based on the evidence gathered, both allegations are determined to be Unfounded, meaning that the allegations are false, could not have happened and/or are 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: 01/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20220217161044

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: 01/27/2026

NARRATIVE

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CONTINUED FROM FORM LIC9099
Regarding the allegation that Facility did not notify responsible party of change of condition for resident, the following has been concluded: R1 was seen by their primary care provider in early January 2022 following the occurrence of a urinary tract infection with the knowledge of R1's attorney-in-fact. Identically, the hospitalization report dated January 20, 2022 shows that the attorney-in-fact and responsible party was informed of the call to the paramedics due to the resident's lethargic state. The admission on hospice care was initiated the same day with full knowledge of the responsible party. Charting notes following R1's readmission at the facility show multiple contacts with R1's family.

Regarding the allegation that Staff mismanaged residents medication, the following has been concluded: It was alleged that after R1 was placed on medication management by facility staff after being assessed to no longer being able to handle their own medication in their physician report reviewed, some PRN medication (nitroglycerin prescribed as needed for R1's heart condition) had been left unaccounted for and accessible to the resident. Aside from one witness statement obtained during the investigation, no evidence of the presence of accessible prescription medication was provided to licensing staff.

Regarding the allegation that Staff did not ensure resident is provided an adequate amount of water, the following has been concluded: Upon being admitted to the Emergency Department at Providence Mission Hospital on January 20, 2022, R1 was diagnosed with acute kidney injury secondary to dehydration and provided with two liters of intravenous liquids. Per the hospital report reviewed, R1 was alert and oriented at the time and was not documented as having any form of severe cognitive impairment. The hospital physician noted that R1 had been refusing to eat and drink in the days prior to the call to the paramedics.

Based on the evidence gathered, the three allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred.

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: 01/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

LIC9099 (FAS) - (06/04)

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