198600459-2-3-2023-11-AS-MVAO-CPWUX7-20230314155751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600459
Report Date: 02/03/2023
Date Signed: 02/03/2023 03:20:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
01/25/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20230125085354

FACILITY NAME:	HERITAGE BOARD & CARE #1		FACILITY NUMBER:	198600459
ADMINISTRATOR:	MARY GRACE TRINIDAD		FACILITY TYPE:	735
ADDRESS:	2330 & 2340 EAST 15TH STREET		TELEPHONE:	(562) 433-7314
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90804
CAPACITY:	42	CENSUS: 32	DATE:	02/03/2023
		UNANNOUNCED	TIME BEGAN:	08:57 AM
MET WITH:	ADMINISTRATOR MARY TRINIDAD		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff did not ensure safety of residents
Facility toilet is in disrepair
Facility bathroom sink is in disrepair
Residents room door is in disrepair
Facility staff does not keep facility free from odor
Facility staff does not keep facility clean
Facility staff use unsanitary gloves to serve food to residents

INVESTIGATION FINDINGS:

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On 02/03/2023 around 09:00 AM Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation for Heritage Board and Care facility to deliver the investigation findings for the allegation listed above. LPA Calderon met with Administrator S1, and the purpose of the visit was explained.

The Investigation consisted of the following: On 02/03/2023 LPA Calderon interviewed R1 for complaint. On 02/03/2023 LPA Calderon interviewed S1-S4 for complaint. On 02/03/2023 LPA Calderon interviewed R2-R4 for complaint. On 02/03/2023 LPA Calderon received and reviewed copies of Staff and Resident rosters, Needs and Service Plan, Pre-Placement Appraisal, Physicians Report, incident report, admission agreement, eviction notice and plumber invoice for resident 1. On 02/03/2023 LPA Calderon and S1 toured the facility to include rooms, bathrooms, kitchen, and all common areas.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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-20230125085354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HERITAGE BOARD & CARE #1	FACILITY NUMBER: 198600459
	VISIT DATE: 02/03/2023

NARRATIVE

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Allegation 1: Facility staff did not ensure safety of residents.
On 02/03/2023 LPA Calderon interviewed R1 for complaint. R1 states that the facility is not safe and other residents are aggressive with R1. On 02/03/2023 LPA Calderon interviewed S1-S4 who states that the facility is safe, the facility has cameras, and the facility doors are locked at night. On 02/03/2023 LPA Calderon interviewed R2-R4 all residents state to feel safe living at the facility. On 02/03/2023 LPA Calderon reviewed facility records for R1. The reports note that R1 has mental health issues and does not take any medication for R1 condition.

Allegation 2: Facility toilet is in disrepair
On 02/03/2023 LPA Calderon interviewed R1 for complaint. R1 states that the bathroom toilet never works, and unknown person clogs the toilet. R1 states that the facility must call a plumber to fix the toilet and R1 can never use the bathroom. On 02/03/2023 LPA Calderon interviewed S1-S4 who state that R1 clogs the toilet all the time to prevent other female residents from using the bathroom. S1-S4 state that a plumber is called many times to fix the damage done by R1. On 02/03/2023 LPA Calderon interviewed R2-R4 for complaint. R2-R4 state that the bathroom toilet is clogged from time to time and there are no issues or concerns using the toilet. On 02/03/2023 LPA Calderon reviewed invoice from plumber fixing the toilet clog due to excessive toilet paper.

Allegation 3: Facility bathroom sink is in disrepair.
On 02/03/2023 LPA Calderon interviewed R1 for complaint. R1 states that the bathroom sink never works and unknown person clogs the sink. R1 states that the facility must call a plumber to fix the sink and R1 can never use the bathroom sink. On 02/03/2023 LPA Calderon interviewed S1-S4 who state that R1 clogs the sink all the time to prevent other female residents from using the bathroom. S1-S4 state that a plumber is called many times to fix the damage done by R1. On 02/03/2023 LPA Calderon interviewed R2-R4 for complaint. R2-R4 state that the bathroom sink is clogged from time to time and there are no issues or concerns using the sink. On 02/03/2023 LPA Calderon reviewed invoice from plumber fixing the sink clog due to excessive toothpaste.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20230125085354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HERITAGE BOARD & CARE #1	FACILITY NUMBER: 198600459
	VISIT DATE: 02/03/2023

NARRATIVE

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Allegation 4: Resident room door is in disrepair.
On 02/03/2023 LPA Calderon interviewed R1 for complaint. R1 states that a unknown person damaged R1 room door many times and that staff has video or this person and will not tell R1 who is damaging R1 room door. On 02/03/2023 LPA Calderon interviewed S1-S4 for complaint. S1-S4 state that R1 has damaged the room door many times by slamming the door when R1 gets made. S1-S4 state that they have fixed R1 room door many times and R1 keeps damaging the door and knob. On 02/03/2023 LPA Calderon walked up to R1 room door and noted the doorknob missing and the door damaged. On 02/03/2023 LPA Calderon reviewed R1 facility records and noted that R1 is dealing with mental health issues and has anger issues.

Allegation 5: Facility staff does not keep facility free from odor.
On 02/03/2023 LPA Calderon interviewed R1 for complaint. R1 states that staff do not clean the facility and there is a odor that is in the rooms and bathrooms. R1 states that R1 has called the health department and they are supposed to come over within 10 days of R1 complaint. On 02/03/2023 LPA Calderon interviewed S1-S4 for complaint. S1-S4 state that there are 2 cleaning staff that work 6 days per week and clean and mop the facility 3 times per day. On 02/03/2023 LPA Calderon interviewed R2-R4 who all state to see staff cleaning the facility every day and have no issues or concerns with the facility staff cleaning or free from odor. On 02/03/2023 LPA Calderon and S1 toured the facility and LPA Calderon noted staff cleaning and noted no issues with the facility. On 02/03/2023 LPA Calderon reviewed R1 facility file and noted that R1 deals with mental health issues, see things that are not there and takes no medication for the condition.

Allegation 6: Facility staff does not keep facility clean.
On 02/03/2023 LPA Calderon interviewed R1 for complaint. R1 states that staff do not clean the facility and there is an odor that is in the rooms and bathrooms. R1 states that R1 has called the health department and they are supposed to come over within 10 days of R1 complaint. On 02/03/2023 LPA Calderon interviewed S1-S4 for complaint. S1-S4 state that there are 2 cleaning staff that work 6 days per week and clean and mop the facility 3 times per day. On 02/03/2023 LPA Calderon interviewed R2-R4 who all state to see staff cleaning the facility every day and have no issues or concerns with the facility staff cleaning or free from odor. On 02/03/2023 LPA Calderon and S1 toured the facility and LPA Calderon noted staff cleaning and noted no issues with the facility. On 02/03/2023 LPA Calderon reviewed R1 facility file and noted that R1 deals with mental health issues, see things that are not there and takes no medication for the condition.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230125085354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HERITAGE BOARD & CARE #1	FACILITY NUMBER: 198600459
	VISIT DATE: 02/03/2023

NARRATIVE

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Allegation 7: Facility staff use unsanitary gloves to serve food to residents.
On 02/03/2023 LPA Calderon interviewed R1 for complaint. R1 states that staff that work in the kitchen where blue gloves for cleaning and then serve food to residents with the same gloves. On 02/03/2023 LPA Calderon interviewed S1-S4 who state that cooking staff where gloves every time the serve food and change gloves many times in the day and when staff are cleaning the kitchen area. On 02/03/2023 LPA Calderon interviewed R2-R4 who all state that the food is good, and they have seen kitchen staff use gloves when serving food to residents. On 02/03/2023 LPA Calderon and S1 toured the kitchen and noted staff wearing gloves while handling food for residents. On 02/03/2023 LPA Calderon reviewed R1 facility records and notes that R1 has mental health issues and see things that are not there and takes no medication for R1 condition.

Although the allegations “facility staff did not ensure safety of residents” “facility toilet is in disrepair” “facility bathroom sink is in disrepair” “residents room door is in disrepair” “facility staff does not keep facility free from odor” “facility staff does not keep facility clean” “facility staff use unsanitary gloves to serve food to residents” 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 S1, and a hard copy was provided

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4