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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600459
Report Date: 04/05/2024
Date Signed: 04/08/2024 09:34:19 AM

Document Has Been Signed on 04/08/2024 09:34 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 #1FACILITY NUMBER:
198600459
ADMINISTRATOR/
DIRECTOR:		MARY GRACE TRINIDADFACILITY TYPE:
735
ADDRESS:2330 & 2340 EAST 15TH STREETTELEPHONE:
(562) 900-5577
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 42CENSUS: 27DATE:
04/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator Mary CruzTIME VISIT/
INSPECTION COMPLETED:
01:24 PM
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On 04/05/2024 at 11:00am, Licensing Program Analysts (LPA) Lizeth Villegas conducted an unannounced case management visit to Heritage Board & Care #1. The purpose of today’s visit is to serve an ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY for staff #1. LPA met with Administrator Mary Cruz as the purpose of today's visit was explained.

An investigation conducted by the California Department of Social Services determined that staff #1 violated California Code of Regulations Title 22 for client's personal rights. Government Code 11522 was also issued, informing the licensee that an excluded person may petition for reinstatement to the Department one year after the effective date of the exclusion order. LPA delivered copies of the immediate exclusion letters for the following facilities to the licensee, Bobby Cato:

· Heritage Board & Care #1-198600459
· Heritage Board & Care #2 -198600456
· Heritage Board & Care #3-306003908
· Heritage Board & Care #4-198600455

Staff #1 was not present at the facility at the time of visit. The Administrator Mary Cruz stated she understands the immediate exclusion order and that she understands the mentioned staff is not allowed to be physically present in the facility.

An exit interview conducted and a copy of this report was provided along with the exclusion letters.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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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