198600455-11-4-2021-11-AS-MCAA-C9C2LP-20211202162950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600455
Report Date: 11/04/2021
Date Signed: 11/04/2021 03:35:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2021 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20211101095024

FACILITY NAME:	HERITAGE BOARD & CARE #4		FACILITY NUMBER:	198600455
ADMINISTRATOR:	WARREN TRINIDAD		FACILITY TYPE:	735
ADDRESS:	1509 EAST 4TH STREET		TELEPHONE:	(562) 437-2070
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	20	CENSUS: 15	DATE:	11/04/2021
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Danny Garcia		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belonging
Staff does not ensure that the facility is free from pests.

INVESTIGATION FINDINGS:

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On 11/04/21 Licensing Program Analyst (LPAs) Jade Jordan And Ngozi Nwakoro conducted an
Unannounced visit regarding the allegations above. LPA’s were met by Facility Administrator Mary Grace Trinidad, and the purpose of the visit was explained.

The investigation Consisted of: Physical Plant tour, Staff/Resident Interviews, Pertinent documents
Requested: Admissions agreement, staff roster, client rosters, Pest control Invoices.

Regarding allegation “Staff did not safeguard resident's personal belonging”
Interviews conducted with Client 1 (C1) alleged that the roommate of C1 has been taking personal belongings. Items stated missing specifically, were magazines, and a Dvd player. C1 stated that they did not lock their items but will do so going forward. C1 stated that they have spoken to staff, but roommate continues to periodically take things and borrow things in the room of C1 without permission. C1 has stated that they have not physically seen roommate take the magazine, or Dvd Player, but it went missing from the room. The Magazine was last seen on C1’s bed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20211101095024

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HERITAGE BOARD & CARE #4	FACILITY NUMBER: 198600455
	VISIT DATE: 11/04/2021

NARRATIVE

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Record Review of C1’s personal Inventory reflected that C1 logged clothing, and no other items. Interviews with other Clients (C2-C5) in care revealed that they generally do not have an issue with other clients, roommates or staff taking their personal belongings, or have things missing.
Therefore; Based on Interviews, Record Review and Observation the LPA finds that
Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Regarding Allegation “ Staff does not keep facility free of pests”

Interview conducted with C1 revealed that they were angry when they contacted licensing because they felt that staff were not helping safeguard items. When interviewed about being bitten by bed bugs and seeing mice, C1 stated that the facility is alright now, and that they had seen the pests in the past, but not recently. Interviews with clients in care, C1-C5 stated that staff clean daily mop, sweep and spray for pests. C1, C3,C5 generally stated that they do not have bed bugs, and have not witnessed mice in their room, or inside of the facility. Record review revealed that the facility uses a contracted pest control monthly. During Physical Tour, LPA’s did not observe Pests such as mice or bed bugs in sampled rooms, or during the physical tour.

Therefore; Based on Interviews, Record Review, and Observation the LPA’s that

Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An Exit interview was conducted, a copy of this report was provided. No citations were issued during this visit.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

LIC9099 (FAS) - (06/04)

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