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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600459
Report Date: 04/10/2023
Date Signed: 04/10/2023 09:23:38 PM

Substantiated


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
04/04/2023 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20230404141503
FACILITY NAME:HERITAGE BOARD & CARE #1FACILITY NUMBER:
198600459
ADMINISTRATOR:MARY GRACE TRINIDADFACILITY TYPE:
735
ADDRESS:2330 & 2340 EAST 15TH STREETTELEPHONE:
(562) 433-7314
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:42CENSUS: 30DATE:
04/10/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:MARILEE CRUZTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee is not properly addressing insect infestation in facility.
INVESTIGATION FINDINGS:
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On 04/10/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced complaint visit at this facility, LPA was greeted by Administrator Marilee Cruz. LPA explained the purpose of the visit is to investigate the allegation mentioned above.

The investigation consists of the following: The complainant requested an investigation regarding the licensee not properly addressing insect infestation in the facility. LPA obtained copies of the facility roster for residents and staff. Interviews conducted with four staff (S1-S4), five clients (C1-C5) and a witness (W1). LPA reviewed facility records pertinent to the allegation on this complaint. A tour of the facility was conducted.

Report continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
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 3
Control Number 11-AS-20230404141503
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: 04/10/2023
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:
Regarding Allegation: Licensee is not properly addressing insect infestation in facility

It was reported that there has been a recurring bed bugs problem in this facility. It was also reported that recently there is an infestation of roaches, but licensee is not properly addressing to resolve this pests issue. Interviews were conducted with four staff (S1-S4), five clients (C1-C5) and a witness (W1). Interviews with S1-S4 revealed a pest control company service the interior and exterior areas of the facility once a month for pests removal and protection. S1 and S2 admitted roaches have been observed in common areas and in client bedrooms. S3 and S4 stated a client bedroom was sprayed for bed bugs treatment about two months ago. During interviews with two clients (C1 and C2), a couple of roaches were recently observed in their bedrooms. Three clients (C3-C5) denied presence of any pests in their bedrooms and in the common areas. During LPA’s tour of the facility, LPA observed some empty client bedrooms have pest control service tags which shows that these bedrooms were serviced on 4/15/23. CB 80 and Transport insecticides were sprayed or applied in these bedrooms to kill pests. Interview with a witness revealed the facility has a month-to-month service contract with a pest control company. A witness (W1) stated this pest control company does not provide fumigation tenting for pests and therefore, the exterminators do not make such recommendation to clients even if necessary. Review of pest control company’s service reports revealed bed bugs treatment was provided to the facility on 4/5/2023 for client bedrooms 4A, 4B, 4D and 5D and all these rooms have bad smell. During year 2020, the facility was serviced monthly for ants, cockroaches and spiders. The facility continued to use the same pest control and treatment, but the pest issue keeps recurring. Based on gathered information, licensee failed to properly address the pest infestation due to the recurring pest infestation problem.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation, "Licensee is not properly addressing insect infestation in facility" is found to be SUBSTANTIATED.



According to the California Code of Regulations (Title 22, Division 6, Chapter 1,6), the following deficiency had been observed and a citation issued (ref. LIC 9099D).

An exit interview was conducted and copy of the Complaint Report and Appeal Rights were provided to the Administrator Marilee Cruz.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20230404141503
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
80087(a)(1)
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80087 Buildings and Grounds(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.(1) The licensee shall take measures to keep the facility free of insects. This requirement is not met as evidence by:
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Administrator shall obtain an alternative pests inspection and shall submit a plan to resolve the pest infestation probem in the interior and exterior grounds of the facility. Administrator shall submit the POC via email to lourdes.montoya@dss.ca.gov by the due date.
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Based on interviews, observations and record review the licensee did not ensure that the facility is free of bedbugs, roaches, ants and spiders. This poses a potential risk to clients' health, safety and/or personal rights.
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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: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC9099 (FAS) - (06/04)
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