<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603778
Report Date: 02/24/2025
Date Signed: 02/24/2025 04:53:38 PM

Document Has Been Signed on 02/24/2025 04:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:HERITAGE HILLSFACILITY NUMBER:
374603778
ADMINISTRATOR/
DIRECTOR:		MICHAEL MCCOYFACILITY TYPE:
740
ADDRESS:2108 EL CAMINO REALTELEPHONE:
(760) 206-7930
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY: 78CENSUS: 64DATE:
02/24/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:45 PM
MET WITH:Executive Director Mike McCoyTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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
Licensing Program Analysts (LPAs) Hannah Rodgers and Sabel Martinez conducted an unannounced Case Management visit to address a deficiency discovered during a complaint investigation. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Executive Director Mike McCoy.

The complaint investigation was regarding an altercation between Resident #1 (R1) and Resident #2 (R2). [See LIC811 Confidential Name List for identification of select person identifiers used in this report.] It was discovered the facility did not conduct a reappraisal of R2 to determine if the facility was an appropriate placement after R2, who exhibited multiple aggressive behaviors towards staff and residents. The facility did not reappraise the resident after the resident demonstrated behavioral expressions resulting in harm to others.

This deficiency was cited in accordance with California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A plan of correction was jointly formulated with Executive Director McCoy.

An exit interview was conducted with McCoy, to whom a copy of this report, LIC 809-D, LIC811, and Licensee Rights (LIC9058), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/24/2025 04:53 PM - It Cannot Be Edited


Created By: Hannah Rodgers On 02/24/2025 at 04:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HERITAGE HILLS
FACILITY NUMBER: 374603778

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/24/2025
Section Cited
CCR
87463(c)(3)

1
2
3
4
5
6
7
Reappraisals (c) If the licensee observes or is made aware of behavioral expression, as defined in Section 87101, that has caused or may cause harm to the resident or others, the licensee shall document all of the following in the resident’s reappraisal: (3) Interventions to be implemented to minimize the risks to the health and safety of the resident or others associated with the resident's behavioral expression. The licensee shall use the least restrictive intervention to manage the behavioral expression based on the individual needs of the resident. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to schedule an in-service training on the topics of Reappraisals and recognizing residents change in behaviors and send proof of scheduling to the Department by 2/25/25. Licensee agrees to send sign-in sheet and training topics to the Department by 3/17/2025.
8
9
10
11
12
13
14
Based on record review and interviews, the licensee did not ensure that R2 received a reappraisal after a significant change in condition and behavioral expression to minimize risks to other residents in care. This posed an immediate safety risk to 70 of 70 residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2