374603778-8-29-2024-08-AS-JROO-DRHSRG-20260221130618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603778
Report Date: 08/29/2024
Date Signed: 08/29/2024 12:56:47 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
08/12/2024 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20240812104805

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:	08/29/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Amanda Togia		TIME COMPLETED:	01:09 PM

ALLEGATION(S):

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Insufficient staffing to meet residents needs.
Facility did not have adequate supplies to meet residents needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Business Office Director Amanda Togia and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of LPA observation, records review and interviews with facility staff, resident and outside sources.

It was alleged that staffing was not sufficient to meet resident's care needs. It was reported that their were not enough staff "NOC" staff to meet all of the residents’ care needs. A comprehensive review of staffing records was conducted for the months of June through August 2024. The records were assessed to determine the number of staff members scheduled and present during all shifts. The records review revealed that staffing levels consistently met the requirements set forth by regulatory standards and internal policies. LPA observed that the number of staff present at the facility was adequate to meet the residents’ needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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 3

Control Number 08-AS-20240812104805

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: 08/29/2024

NARRATIVE

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Records review further revealed that the resident census on the 1st floor and 2nd floor had an average of 36 residents. The AM staffing ratio on both floors was regularly at; three caregivers and one med-tech. The PM staffing ratio was regularly at three caregivers and one med-tech . The NOC staffing ratio was regularly at two caregivers and one med-tech for both floors. The staffing schedule also revealed an outside agency had been utilized to assist with staff vacancies. Analysis of staffing schedules showed that the facility maintained adequate staffing ratios to address the needs of residents.

LPA interviewed a 2nd floor resident who stated that they have lived at the facility for 2.5 years. Resident stated that they are very happy at the facility. Resident stated the facility staff are "wonderful" and they feel "blessed" to live there. Resident further stated that they get "fast help from staff" whenever needed.

It was also alleged that the facility did not have adequate supplies to meet residents needs. It was reported that the facility was low on various sanitary and medical supplies. It was also reported that staff did not have access to the supply room during the NOC shift. LPA visited the facility on July 29,2024. LPA inspected two supply rooms on the second floor. One main supply room with large boxes and supplies that was locked and a second unlocked supply closet with various materials and supplies stored on shelves. LPA observed that the facility had an adequate supply of materials necessary for resident care, including medical supplies, personal hygiene items, and other essential resources.

A review of facility records revealed a supply invoice dated July 5, 2024. The invoice included a sufficient amount of small, medium, large, and extra-large adult briefs, wipes, and gloves.

Interview with Resident Services Director (RSD) revealed that the main supply room can be accessed by two other staff members and the maintenance worker. RSD stated that the supply closet is available to all of the staff members and the main supply room can be accessed any time of day if needed. RSD further explained that although she purchases supplies for all of the resident's, some residents' choose to purchase their own incontinence supplies, etc. RSD explained that the main supply room has boxes labeled for specific residents that purchase their own supplies and/or receive supplies from various programs. ED stated that as a result the main supply room must be closely monitored so that staff members do not disperse the various supplies incorrectly.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20240812104805

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: 08/29/2024

NARRATIVE

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LPA reviewed the facility standardized admission agreement. The agreement revealed residents have the option of purchasing their own incontinence supplies or they can pay an additional monthly fee to have the facility provide the supplies.

LPA interviewed outside agency (OA). OA also reviewed the facility’s supply inventory and agreed with the LPA’s assessment, confirming that the supplies available were sufficient to meet the residents’ needs. OA agency stated from their assessment the facility has sufficient staff to meet the needs of the residents.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

An exit interview was conducted with Amanda Togia. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Amanda Togia whose signature below verifies receipt of these right

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC9099 (FAS) - (06/04)

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