198600456-10-5-2021-11-AS-JHAD-C9KQ99-20211210105757

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600456
Report Date: 09/16/2021
Date Signed: 10/05/2021 03:38:16 PM

Unsubstantiated

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
08/16/2021 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20210816113555

FACILITY NAME:	HERITAGE BOARD & CARE #2		FACILITY NUMBER:	198600456
ADMINISTRATOR:	MARY GRACE TRINIDAD		FACILITY TYPE:	735
ADDRESS:	2445 PACIFIC AVENUE		TELEPHONE:	(562) 424-1728
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	18	CENSUS: 18	DATE:	09/16/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	ADMINISTRATOR MARY TRINIDAD		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff are not administering medication
Staff are not safeguarding residents property
Staff are not providing an adequate amount of food
Resident care needs are not being met

INVESTIGATION FINDINGS:

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On 08/16/2021 around 1pm Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. LPA Calderon met with Administrator Mary Trinidad and the purpose of the visit was explained.

The Investigation consisted of the following: On 08/17/2021 LPA Calderon interviewed W1. On 08/20/2021 LPA Calderon interviewed reporting party for complaint. LPA Calderon interviewed Administrator Mary Trinidad on 08/23/2021and conducted a tour of the physical plant. On 08/23/2021 LPA Calderon interviewed S2 and R1 plus obtained copies of Staff and Resident rosters, Resident #1’s record (Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months), Physicians Report and Medication list). On 10/05/2021 LPA Calderon interviewed R2-R6 for complaint.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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 3

Control Number 11-AS-20210816113555

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 #2	FACILITY NUMBER: 198600456
	VISIT DATE: 09/16/2021

NARRATIVE

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Allegation: Staff are not administering medication
It is alleged that Staff are not administering medication. On 08/17/2021 LPA interviewed W1 who states that R1 had come over to her assisted living home to visit and W1 states that R1 deals with schizophrenia and takes medication for the mental condition. W1 does not have any proof that staff are not giving R1 his medication. LPA interviewed W2 who states she does not have any proof that the facility is not giving R1 his medication. LPA interviewed R1 who states that the facility denies him his medication even though they know he battles with schizophrenia. R1 states that he never refuses to take his medication when given. LPA interviewed S1-S2 both states that they give R1 medication to him daily and that R1 refuses to take his medication. On 08/26/2021 LPA reviewed facility paperwork on R1 and stated that R1 deals with Schizophrenia and makes up stories. On 10/05/2021 LPA Calderon interviewed R2-R6 all states that the facility and staff gives them their medication and does not make any mistakes.

Allegation: Staff are not safeguarding resident’s property
It is alleged that Staff are not safeguarding resident’s property: LPA interviewed W1-W2 both states that R1 is missing his cell phone and personal items but cannot states what happened to R1 personal items. LPA Calderon interviewed R1 who states he lost his cell phone when he dropped the phone and could not remember where he left the phone. R1 does not have any proof that other residents are stealing his person items. LPA Calderon interviewed S1-S2 both states that there is no record of anyone stealing R1 cell phone or personal items. On 10/05/2021 LPA Calderon interviewed R2-R6 who all states that the facility supplies them with a locker and their property is safe.

Allegation: Staff are not providing an adequate amount of food
It is alleged that Staff are not providing an adequate amount of food: LPA interviewed W1-W2 both stated that R1 comes to their sober living facility and residential care facility and they feed him food all the time. W1-W2 states that R1 tells them that the facility does not give him any food, but they cannot prove this allegation. LPA Calderon interviewed R1 who states he made up the story and is given 3 meals a day and is just hungry. LPA Calderon interviewed S1-S2 both stated that R1 is fed 3 meals a day not including snacks and R1 does not miss his meals. On 10/05/2021 LPA Calderon interviewed R2-R6 all stated that they are given 3 meals per day and do not go hungry.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210816113555

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 #2	FACILITY NUMBER: 198600456
	VISIT DATE: 09/16/2021

NARRATIVE

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Allegation: Resident care needs are not being met
It is alleged that Resident care needs are not being met: LPA interviewed W1-W2 both stated that R1 states to them that the facility does not care for his needs and that R1 roommate has told him that he plans to kill him if he does not move. W1-W2 do not have any proof and did not call the police. LPA Calderon interviewed R1 who stated that his roommate has told him he plans to kill him unless he moves out. R1 stated he did not call the police or inform staff and has no proof this happened. LPA Calderon interviewed S1-S2 both stated R1 mental condition and that R1 never advised them of any issues with his roommate and R1 did in fact attack Staff 2. S1 states they called the police who arrived to arrest R1, but R1 took off prior to the police showing up. On 10/05/2021 LPA Calderon interviewed R2-R6 who states that the staff takes care of all their needs.

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.

A telephonic exit interview was conducted with Administrator Mary Trinidad, and a hard copy was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC9099 (FAS) - (06/04)

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