374603778-10-24-2024-08-AS-JROO-DRHTTP-20260221140103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603778
Report Date: 10/24/2024
Date Signed: 10/24/2024 02:36:39 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
09/03/2024 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20240903100613

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: 76	DATE:	10/24/2024
		UNANNOUNCED	TIME BEGAN:	10:14 AM
MET WITH:	Evalyn Valaile		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff did not prevent outbreak of covid.

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 Resident Services Director Evalyn Valaile and we discussed the purpose of the visit and elements of the complaint.

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

It was alleged that staff failed to prevent a covid outbreak. It was reported that Resident 1 (R1(an LIC 811 Confidential Names List was provided to the facility representative to identify the resident) was transported to the hospital due to labored breathing, where they subsequently tested positive for COVID-19. It was reported that additional residents on the first floor also tested positive for covid-19, leading to allegations that staff failed to prevent a COVID-19 outbreak in the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

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-20240903100613

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: 10/24/2024

NARRATIVE

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The facility has an infection control plan in place that includes isolating covid positive residents during their infectious period. This protocol was reviewed and found to have been followed appropriately in the cases reported. Interviews with staff confirmed that the positive residents were isolated, and proper protocols were implemented once covid cases were identified, including; two hour checks, food delivered to resident's rooms and covid testing for symptomatic residents.

Records review revealed incident reports were submitted to CCL on August 14, 2024. The incident reports indicated that five residents tested positive for Covid-19 and were immediately placed in quarantine with a "PPE isolation cart" placed outside of their door. A transmission precaution sign was also placed on each of the resident's door. All of the covid positive resident's responsible parties and Physicians were notified. LPA interviewed several of the residents that were previously covid positive. All of the residents interviewed stated that they were instructed by facility staff to self isolate in their rooms. One of the residents interviewed stated that the covid positive residents had their meals delivered to their rooms while they were sick and infectious.

While residents were encouraged to wear masks and utilize PPE, it was noted that adherence to these guidelines varied, particularly among residents with cognitive impairments who may not fully understand the necessity of such measures.

An interview with an outside source (OS) revealed no knowledge or evidence to substantiate the allegation that staff did not take appropriate actions to prevent the COVID outbreak. OS noted that the facility seemed to be following recommended protocols.

LPA interviewed Business Office Director (BOD) who stated that when a covid case occurs at the facility the resident is placed on isolation and PPE supplies are placed outside of their room. Meals are served in resident's room and disposable plates and utensils are utilized until the covid case is resolved. Vitals are taken "Q-shift" and PRN. Residents with covid symptoms are tested and all staff, visitors and residents are encouraged to wear masks.

The investigation indicates that while the facility faced challenges inherent in caring for residents with cognitive impairments, it followed its established infection control protocols.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240903100613

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: 10/24/2024

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is not valid. An exit interview was conducted with Evalyn Valaile. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Evalyn Valaile whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

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