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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600459
Report Date: 04/24/2025
Date Signed: 04/24/2025 12:40:27 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/04/2025 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20250404151516
FACILITY NAME:HERITAGE BOARD & CARE #1FACILITY NUMBER:
198600459
ADMINISTRATOR:MARILEE CRUZFACILITY TYPE:
735
ADDRESS:2330 & 2340 EAST 15TH STREETTELEPHONE:
(562) 900-5577
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:42CENSUS: 36DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Licensee Marilee Cruz TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff do not treat residents with dignity and respect.
INVESTIGATION FINDINGS:
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On 04/24/25 at 9am Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Licensee Marilee Cruz as the purpose of today’s visit was explained.

The investigation consisted of the following: On 04/09/25 LPA Villegas obtained copies of the staff and resident roster, and requested the following documents for client #1 (C1) facesheet, admission agreement dated: 12/9/24, personal rights dated 12/9/24, physicians report dated: 9/19/24, needs and service plan dated: 3/11/25, medication administration records for March-April 2025, public guardian business card, and a copy of invoice dated 4/1/24. On 04/09/25 from 10am-11:22 am LPA conducted interviews with clients 2-5 (C2-C5). On 04/17/25 from 11:35am-11:45am LPA conducted interview with C1. On 04/09/25 from 12pm-12:40 pm LPA conducted interview with Licensee (L1), and at 12:40pm LPA conducted a tour of the facility including facility kitchen and pantry. On 04/17/25 LPA conducted medication review, and from 1pm-2:00pm LPA conducted interview with staff #2-4 (S2-S4). On 4/24/25 from 10:50am -11:03 am LPA
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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-20250404151516
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 #1
FACILITY NUMBER: 198600459
VISIT DATE: 04/24/2025
NARRATIVE
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conducted interview with staff #1 (S1).

The investigation revealed the following:

Allegation: Staff do not treat residents with dignity and respect.
It is being alleged that facility staff staff call clients in care names. On 04/09/25 from 12pm-12:40 pm LPA conducted interview with L1 regarding the allegation above, L1 denied the allegation above and reported that the clients are the ones who call the staff names. On 04/09/25 from 1pm-2:00pm LPA conducted interview with S2-S4, 3 of 3 staff denied the allegation above, per 1 of the 3 staff interviewed staff get called names by the clients in care but staff do not respond back. On 04/09/25 and 4/17/25 LPA conducted interviews with C1-C5 regarding the allegation above, 3 of 5 clients interviewed denied the allegation above, 1 of 5 clients interviewed denied the allegation above but reported that staff member has an attitude, 1 of 5 clients interviewed confirmed the allegation above and reported being yelled at, hit, and disrespected by staff. On 4/24/25 from 10:50am -11:03 am LPA conducted interview with S1 regarding the allegation above, S1 denied the allegation above and reported that the licensee would have spoken to S1 about the allegation if it had occurred.

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.

Exit interview conducted, and a copy of this report was provided to Licensee.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250404151516
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 #1
FACILITY NUMBER: 198600459
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/25/2025
Section Cited
CCR
80019(e)(2)
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80019 Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working...Obtain a California clearance or a criminal record exemption as required by the Department. Based on records
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Licensee will request a criminal record exemption via Guardian for staff #1. Staff #1 shall not be scheduled for work until licensee obtains criminal record exemption approval from Guardian. Licensee to submit proof of criminal records exemption to LPA by POC due date.
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review and interview the Licensee did not comply with the section cited above as staff #1 does not have a required criminal record exemptions which poses/posed a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
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