198600455-4-30-2025-11-AS-UCOL-DGTS2V-20250519133005

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600455
Report Date: 04/30/2025
Date Signed: 04/30/2025 04:59:41 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
04/25/2025 and conducted by Evaluator Regina Cloyd

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250425145408

FACILITY NAME:	HERITAGE BOARD & CARE #4		FACILITY NUMBER:	198600455
ADMINISTRATOR:	MARILEE CRUZ		FACILITY TYPE:	735
ADDRESS:	1509 EAST 4TH STREET		TELEPHONE:	(562) 900-6257
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	20	CENSUS: 16	DATE:	04/30/2025
		UNANNOUNCED	TIME BEGAN:	09:49 AM
MET WITH:	Mary Cruz		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff do not allow residents to possess cash resources.
Staff do not safeguard clients' personal belongings.
Staff do not allow guests to visit clients at facility.

INVESTIGATION FINDINGS:

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On 04/30/25, Licensing Program Analyst (LPA) Regina Cloyd conducted a(n) initial/subsequent visit on to gather information regarding the above allegation(s). LPA met with Administrator Assistant Mary Cruz and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following: On 04/29/25, LPA interviewed one client over the phone. On 04/30/25, LPA reviewed Register of Facility Client Roster (dated 08/01/2024, Staff Roster (dated 01/02/25), Facility Menu (Week 1 – 4), and Client Records for Clients #1-5. LPA interviewed Administrator Assistant, House Manager, Housekeeper and three clients and one client over the phone. LPA toured the facility with the House Manager.

Continue to LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

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-20250425145408

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: 04/30/2025

NARRATIVE

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Investigation revealed the following:

Allegation: Staff do not allow residents to possess cash resources.

Regarding the allegation "Staff do not allow residents to possess cash resources,” it is being alleged that Staff misuse residents' money and do not allow residents to keep any of their money for themselves. Record review of P & I (Clients #1 – 5 ) revealed clients were able to withdraw all of their April money. The facility did not manage one client’s P & I. Record review of Physician’s Report (Clients #1 – 5) revealed three out of five clients are able to manage their own P & I. Interview with the Administrator Assistant indicated that clients, case workers, and family members prefer for the facility to manage clients’ P & I. Interviews with Staff #2 indicate P & I is distributed on Tuesdays and Thursdays and there has been no complaints. # out of # Clients (#1 -5) indicated they have no complaints with their P & I money. Three out of four clients indicated they have no complaints with their P & I money.

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

Allegation: Staff do not safeguard clients' personal belongings.

Regarding the allegation "Staff do not safeguard clients' personal belongings,” it is being alleged that staff took clients’ personal belongings (i.e., radio) from them. It was also alleged that $200 came up missing from resident’s room. Three out of three staff (S1 – S3) interviews indicated the staff do safeguards the clients’ personal belongs. Staff indicated that clients are able to lock their doors. Interview with the Administrator Assistant indicated clients often loan each other items and nothing of major value, including radio and $200, has been stolen nor reported. Three out of five client (#1-5) interviews indicated staff do safeguard their personal belongings. Record review of client/resident personal property and valuables (Clients #1 – 5) revealed two out of five clients have the document completed.

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

Continue to LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250425145408

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: 04/30/2025

NARRATIVE

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Allegation: Staff do not allow guests to visit clients at facility.

Regarding the allegation "Staff do not allow guests to visit clients at facility,” it is being alleged Staff told a visitor would not allow residents’ guest inside of the facility and a “no visitor” sign was put up afterwards. LPA observed two COVID notices concerning visitations inside of the facility and two “no trespassing” signs outside of the facility. Three out of three staff (1 – 3) interviews indicated clients are allowed to have guests in the common areas and front yard. Interview with the Administrator Assistant indicated that if they see that the visitor is causing problems then the facility has a “no trespassing” sign posted. Three out of four client (#2 – 4) interviews indicated they are allowed to have visitors in the common areas or on the front porch. One of the four clients were unaware if they could have visitors.

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

No deficiencies issued.

An exit interview was conducted, and a copy of this report was reviewed and left with the Administrator Assistant Mary Cruz.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

LIC9099 (FAS) - (06/04)

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