198600455-5-29-2024-11-AS-RORN-D65PVL-20240611113920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600455
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:09:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/22/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20240522155601

FACILITY NAME:	HERITAGE BOARD & CARE #4		FACILITY NUMBER:	198600455
ADMINISTRATOR:	WARREN TRINIDAD		FACILITY TYPE:	735
ADDRESS:	1509 EAST 4TH STREET		TELEPHONE:	(562) 900-6257
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	20	CENSUS: 12	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Mary Cruz		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not safeguard residents personal property.
Staff harassed Resident.
Facility is disrepair.

INVESTIGATION FINDINGS:

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On 05/29/24, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced visit to the facility at 10:02 AM and was greeted by the House Manager Danny Garcia (HM). LPA Richard explained the purpose of this visit is to conduct a complaint allegation pertaining to the above-mentioned allegations. Later LPA was joined with Administrator Mary Cruz.

The investigation Consisted of the following: On 05/29/24, LPA Richard, Administrator Cruz, and House Manager Garcia toured the facility inside and out. LPA Richard reviewed, requested, collected client's records and facility financial statement. LPA reviewed five clients’ files (C1-C5) and five staff files (S1-S5). LPA interviews five clients (C1-C5) and two staff the Administrator (A1) and the House Manager (HM2).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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 4

Control Number 11-AS-20240522155601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HERITAGE BOARD & CARE #4	FACILITY NUMBER: 198600455
	VISIT DATE: 05/29/2024

NARRATIVE

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Allegation 1: Licensee did not safeguard resident personal belongings.

The complainant alleges facility did not safeguard resident’s personal belongings. LPA interviewed Administrator Mary Cruz (A1) denied the allegation. A1 stated that the client C1 and the case manager took all the belongings with them when they left the facility on 04/29/24. On 05/02/24, records reviews showed that A1 texted the Community Health worker about C1 P&I money that was received on 04/30/24 after C1 left the facility. The administrator was instructed to email a different agency about the P&I money since the C1 was no longer living at the facility. On 05/29/24, LPA Richard reviewed and obtained the financial records that showed the facility did get C1 P&I money the day after C1 left on 04/30/24. LPA interviewed Community Health Workers who supported the statement. LPA interviewed five clients (C2-C6) and asked if they had any property stolen or missing items those interviewed 5 out of 5 clients stated that they never had anything stolen. LPA interviewed five clients about receiving their P&I money, all five clients 5 out of 5 stated that they received their P&I money every Tuesday and Thursday without any problem. LPA interviewed the house manager (HM2) who stated that the client had never mentioned missing personal belongings from their rooms.

Based on interviews and records review there is insufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240522155601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HERITAGE BOARD & CARE #4	FACILITY NUMBER: 198600455
	VISIT DATE: 05/29/2024

NARRATIVE

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Allegation 2: Staff Harassed Resident.

Regarding the allegation: "Resident is being harassed, bodily harm while in care."

During Today’s visit, the administrator (A1) and house manager (HM2) all denied harassing any clients while in care. During today’s visit 5 out of 5 clients interviewed also denied being harassed by staff. On 05/28/24, LPA Richard Interviewed the reporting party, (RP) who retracted the harassment statement from the original allegation. The reporting party stated that the client was accused of harassing the staff. Based on interviews and RP statement, there is insufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation 3: Facility is disrepair.

Regarding the allegation: Facility is in disrepair and inhabitable living condition.

LPA interviewed Administrator Mary Cruz (A1), who denied the allegation. The administrator A1 stated that the facility was not in disrepair. LPA interviewed five clients (C2-C6) 5 out of 5 clients rejected the assertion that the facility was in disrepair. The house manager stated that the facility was not in disrepair, and that no one had complained that it was. LPA toured the facility inside and outside grounds, and LPA Richard did not observe the inside or outside facility grounds to be in disrepair.

Continued.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20240522155601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HERITAGE BOARD & CARE #4	FACILITY NUMBER: 198600455
	VISIT DATE: 05/29/2024

NARRATIVE

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LPA observed it to be well maintained and in no way in disrepair. All rooms, bathrooms, and exteriors were checked and found to comply with Title 22 regulations.

Based on interviews and observations, there is insufficient evidence to support the allegation that the facility is in disrepair. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies cited. Exit interview conducted a copy of this report was provided to the House Manager Danny Garcia.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

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