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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600456
Report Date: 01/19/2024
Date Signed: 01/19/2024 02:58:27 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, 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
12/27/2021 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20211227094948
FACILITY NAME:HERITAGE BOARD & CARE #2FACILITY NUMBER:
198600456
ADMINISTRATOR:MARY GRACE TRINIDADFACILITY TYPE:
735
ADDRESS:2445 PACIFIC AVENUETELEPHONE:
(562) 424-1728
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:18CENSUS: 17DATE:
01/19/2024
UNANNOUNCEDTIME BEGAN:
02:28 PM
MET WITH:Mary CruzTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff sexually assaulted client in care.
INVESTIGATION FINDINGS:
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On 01/19/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced visit to the facility listed above. LPA met with Administrator, Mary Cruz and the purpose of today’s visit was explained. The purpose for today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegation.
An initial visit was conducted by LPA Don Senaha and Investigation Bureau Investigator (IB), Ryan Miles, on 12/28/21.
The investigation consisted of the following: On 12/27/21, the complaint was accepted by the CCL IB investigation Unit, and assigned to IB Investigator Ryan Miles. On 12/28/21, LPA Senaha and IB Miles conducted a visit and requested and received resident roster, staff roster, and other service documents. A plant inspection of the facility was conducted. IB Miles conducted interviews with residents (R1-R3), staff from the facility (S1-S2), and witness (W1).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
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 2
Control Number 11-AS-20211227094948
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HERITAGE BOARD & CARE #2
FACILITY NUMBER: 198600456
VISIT DATE: 01/19/2024
NARRATIVE
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Investigation Revealed the following:

Allegation: Staff sexually assaulted client in care.

The staff roster and Community Care Licensing Division (CCLD) personal summary report confirmed there is no staff by the name indicated in the allegation listed above. LPA observed and reviewed staff roster confirming there is no staff by the name indicated in the allegation who is an employee at the facility. During interviews, residents (R1-R3), staff (S1-S2) and witness (W1) stated there is no staff by the name indicated in the allegation who is an employee at the facility. During an interview with Resident (R1) they denied being sexually assaulted at the facility on Sunday 12/26/21. Based on information gathered, the Department found there is no evidence to corroborate the allegation “staff sexually assaulted client in care.”

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.

An exit interview was conducted with Administrator, Mary Cruz, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2