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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200506
Report Date: 07/16/2026
Date Signed: 07/22/2026 02:08:39 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2026 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20260707133535
FACILITY NAME:HERITAGE HAVENFACILITY NUMBER:
019200506
ADMINISTRATOR:FERDINAND GUTIERREZFACILITY TYPE:
740
ADDRESS:389 JUANA AVENUETELEPHONE:
(510) 357-1300
CITY:SAN LEANDROSTATE: ZIP CODE:
94577
CAPACITY:27CENSUS: 17DATE:
07/16/2026
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Ferdinand Gutierrez, Administrator TIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident physicially assaulted another resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
***This is an amended report from visit on 7/16/2026***

On 7/16/2026 at 3:45 pm, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct an a complaint investigation and deliver findings in regards to the allegation above. LPA met with Ferdidnand Gutierrez, Administrator and informed the reason for visit.

During investigation, LPA obtained and reviewed the resident roster and staff roster. LPA interviewed Staff (S1 and S2) and Residents (R1, R2, and R3).

Allegation: Resident physicially assaulted another resident
Finding: Unfounded

Continue to LIC9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
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 2
Control Number 15-AS-20260707133535
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: HERITAGE HAVEN
FACILITY NUMBER: 019200506
VISIT DATE: 07/16/2026
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
***This is an amended report from visit on 7/16/2026***

Continued from LIC9099.

During investigation, LPA interviewed staff and residents. Interviews with staff revealed that W2 has never been a resident at this facility before and they do not know who W2 is. S1 stated that W3 was a resident here around 2011 but was discharged over 3 years ago. S2 stated that they do not know W3. Staff stated that there have not been any recent incidents regarding resident altercations. Interviews with residents revealed that they do not know W2 or W3 and they have not witnessed any recent altercations between residents. No forthcoming information provided by reporting party. Therefore, LPA was unable to determine the details of alleged incident.

This agency has investigated the complaint on the above allegation, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

No deficiency cited. Exit Interview conducted with Ferdinand and copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2