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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600459
Report Date: 01/04/2024
Date Signed: 01/04/2024 09:54:32 AM


Document Has Been Signed on 01/04/2024 09:54 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:MARY GRACE TRINIDADFACILITY TYPE:
735
ADDRESS:2330 & 2340 EAST 15TH STREETTELEPHONE:
(562) 900-5577
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:42CENSUS: 20DATE:
01/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:ADMINISTRATOR MARY TRINIDADTIME COMPLETED:
10:15 AM
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On 01/04/2024 around 09:00am Licensing Program Analyst (LPA) Jose Calderon initiated an announced Case Management - Other to Heritage Board & Care provide Technical Assistance to the above said facility.
A tour of the facility's common areas was conducted by LPA Calderon was given a tour of the facility's main building by administrator Mary Trinidad. The tour consisted of a single-story commercial building, all common areas which included but were not limited to, building entrances, reception areas, office, hallways, public restrooms, dining room, kitchen, pantry, medication storage and patio area. LPA also reviewed the facility's entry procedures, body temperature monitoring practices, social distancing practices, protective facial covering practices and disinfection/sanitation practices with Administrator Mary Trinidad.

The LPA Calderon also requested copies of the facility's records which include but are not limited to incident report (date 12/09/2023), Telecare client paperwork (date 12/08/2023). LPA Calderon conducted an interview with Administrator Mary Trinidad. Administrator Trinidad states that on 12/08/2023 the administrator Galvin Toschiki with Telecare 562 332 4393 with no notice. Staff states that a client Ben Gray advised facility staff that he was moving. Staff states that Telecare had 10 clients living in the facility. The Telecare Administrator came with a van and started to move residents out of the facility. The administrator states she does not know where Telecare staff had moved the 10 residents. Staff states that the Telecare staff did not give the facility any paperwork. Staff state that Telecare staff are supposed to give a 30-day notice that Telecare is to move residents from the facility. Staff state that a list of residents was given to the LPA manager. LPA Calderon conducted an interview with Galvin Tochiki with Telecare. The administrator claims that they pulled their clients out of the facility for safety reasons and reported the issues with APS and CCL. The administrator will email LPA Calderon the location of the 10 telecare clients and the allegations claimed. gtochiki@telecarecorp.com

A telephonic exit interview was conducted with administrator Mary Trinidad and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024
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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