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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600456
Report Date: 11/15/2024
Date Signed: 11/15/2024 10:36:51 AM

Document Has Been Signed on 11/15/2024 10:36 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 #2FACILITY NUMBER:
198600456
ADMINISTRATOR/
DIRECTOR:		MARILEE CRUZFACILITY TYPE:
735
ADDRESS:2445 PACIFIC AVENUETELEPHONE:
(562) 900-6334
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 18CENSUS: 16DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:06 AM
MET WITH:Administrator Marilee Mary CruzTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 11/15/24, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Marilee Mary Cruz as the purpose of today’s visit was explained. The facility is licensed for 18 developmentally disabled adult clients, current census is 16. Administrator provided with upcoming fees ($908) info and pin.

The facility is a single-story structure located in a residential neighborhood and consists of the following: (11) client bedrooms, (2) client bathrooms with multiple stalls, meeting area/ dining room, kitchen/medication room, 1 staff bedroom, 1 staff restroom, washer and dryer room, and a two sided shaded porch area. Perishable and non-perishable food supply was checked and adequately stocked at time of visit, pantry was stocked. All food supplies labeled with expiration dates. Toxins and knifes were observed to be stored and inaccessible to clients. Facility has an active surety bond, land-line and internet service observed. There are no bodies of water nor firearms on the property, exits and walkways are free of debris/hazards.

LPA conducted a records review of 3 staff records, 5 client records, 5 P&I ledgers, and 5 medication administration records. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 10/06/24, fire extinguisher fully charged, carbon monoxide and smoke detectors are operational.

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

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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