198600455-5-1-2025-11-AS-UCOL-DGTS2U-20250519133005

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600455
Report Date: 05/01/2025
Date Signed: 05/01/2025 11:31:18 AM

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:	05/01/2025
		UNANNOUNCED	TIME BEGAN:	08:31 AM
MET WITH:	Mary Cruz		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff forced a client to reside in the room with a client of a different gender.
Staff do not serve clients food of good quality.
Staff speak inappropriately to client.
Staff do not provide client with comfortable environment.
Staff illegally evicted client.

INVESTIGATION FINDINGS:

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On 05/01/25, Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent visit 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. On 05/01/25, LPA interviewed the House Manager and Clients #1 and #3.

Continue to LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

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: 05/01/2025

NARRATIVE

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Allegation: Staff forced a client to reside in the room with a client of a different gender.
Regarding the allegation "Staff forced a client to reside in the room with a client of a different gender,” it is being alleged that a Client #1 (C1) is forced to room with a transgender Client (C3). It is also alleged that C3 stares at and is disrespectful to C1. It is alleged that C1 is uncomfortable and the request for a room change has been ignored. Interview with Administrator Assistant and Staff #2 denied the allegation and indicated they have not received a room change request from C1. Record review of C3’s Physician Report does not reveal a sex. Interview with C1 indicated that the request was discussed with Staff #2. Interview with C3 did not address the allegation directly but indicated that C3 and C1 has a good relationship and C3 is comfortable in the room. Interview with Client #5 (C5) indicated that C5 has roomed with a transgender client and was comfortable. C5 also indicated staff has responded to C5’s roommate requests in the past and it was done in two – three days. Interview with Client #2 indicated staff ignore room changes and Client #4 did not deny nor agree with the allegation.

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 serve clients food of good quality.
Regarding the allegation "Staff do not serve clients food of good quality,” it is being alleged that clients are served low quality food such as a chicken patty with frozen vegetables. On 04/30/25, record review of week four’s menu revealed hashbrown, bacon, and toast was served for breakfast. Chips for 10:00am snack. Soup or sandwich for lunch. Pudding for 2:00pm snack. Spaghetti, meatballs, and salad for dinner. Cookies for 7:00pm snack. Three out of three staff interviews indicated they have not received complaints about the quality of food. Three out of five client (#1 – 5) interviews indicated that the quality of food is average. On 04/30/25, LPA observed two cheese burritos, egg soup, and tortilla chips being served for lunch. LPA observed pasta with ground beef, salad, toast, and two orange slices being served for dinner. Around 1:30 PM, LPA observed groceries being delivered. During the facility tour, LPA observed multiple meats in the deep freezer. In the refrigerator, LPA observed meats, cheese, condiments, eggs, bread, tomatoes, and two oranges. LPA observed green beans, ravioli, cream of mushroom soups, condiments, peanut butter, cornbread and pancake mix, chips, cereal, oatmeal, cream of wheat, pasta, ramen, beans, and rice in the pantry. LPA observed frozen bread, hash browns, vegetables, and bagels in the second freezer. 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 LIC9099C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

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: 05/01/2025

NARRATIVE

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Allegation: Staff speak inappropriately to client
Regarding the allegation "Staff speak inappropriately to client,” it is being alleged that Staff bullies the clients, tell them not to speak to them, and refer to clients as inmates.
Three out of three staff (#1 – 3) interviews denied that the allegation occurred. Four out of five clients (#1 – 5) interviews denied that the allegation occurred.

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.

Allegations: Staff do not provide client with comfortable environment.
Regarding the allegation "Staff do not provide client with comfortable environment,” it is being alleged that Staff took Client #2’s (C2) walker away because Staff did not want to mess up the floors. Interview with C2 denied the allegation and said the walker is only used for physical therapy. Three out of three staff (#1 – 3) interviews denied the allegation. On 04/30/25, LPA observed the walker folded up in the client’s room. Record review of C2’s physician report revealed the client to be ambulatory (05/16/24). Record review of the facility’s license revealed it is for ambulatory clients only.

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 illegally evicted client.
Regarding the allegation "Staff illegally evicted client,” it is being alleged that Client #2 (C2) was kicked out of the facility and is still in the hospital. Record review of incident report revealed C2 fell about one mile away from the facility and was taken to the hospital on 04/21/25. Record review of the facility’s license revealed it is for ambulatory clients only. Interview with C2 indicated that the Administrator Assistant told C2 that she could not return because C2 has a walker. Interview with the Administrator Assistant indicated that according to the hospital, C2 is completely non-ambulatory. Administrator Assistant indicated that an eviction notice has not been issued to C2.

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.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

LIC9099 (FAS) - (06/04)

Page: 3 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: 05/01/2025

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	No deficiencies were issued. An exit interview was conducted, technical assistance provided, and a copy of this report was reviewed and provided to the Administrator Assistant Mary Cruz.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4