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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600456
Report Date: 12/02/2025
Date Signed: 12/02/2025 04:23:45 PM

Document Has Been Signed on 12/02/2025 04:23 PM - 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: 15DATE:
12/02/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:22 PM
MET WITH:Marilee Cruz - AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:38 PM
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On 12/02/25, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Marilee "Mary" Cruz and the purpose of today’s visit was explained. The facility is licensed for 18 developmentally disabled adult clients, current census is 15. Annual fees are current.

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 stored during the time of today's visit. All food supplies are 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 and exits / walkways are free of debris/hazards and/or obstruction. LPA observed the screens in certain resident(s) areas needing to be repaired/replaced as well as small flies in room number five (#5). LPA and Administrator have agreed window screens shall be in good repair and will be repaired and corrected within 48 hours and photographs will be forwarded to LPA, confirming window screens shall be in good repair and be free of insects. LPA has written two technical advisory notes. Please see LIC9102TA.

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 drill was conducted on 09/15/25, all three (3) fire extinguishers fully charged and were annually checked on 04/02/25 along with a most recent Fire Protection & Life Safety Equipment Performance Certificate provided on 09/23/25 by carbon monoxide and smoke detectors are operational.

There have been zero (0) deficiencies cited during today's visit. An exit interview was conducted with Marilee "Mary" Cruz - Administrator, and a copy of this report has been provided.

NAME OF LICENSING PROGRAM MANAGER: Ulysses Coronel
NAME OF LICENSING PROGRAM ANALYST: Mario Leon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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