198601343-10-10-2024-11-AS-JHAD-DAGPWW-20241028114121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601343
Report Date: 10/10/2024
Date Signed: 10/10/2024 11:42:50 AM

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
09/23/2024 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240923094104

FACILITY NAME:	HERITAGE HOUSE		FACILITY NUMBER:	198601343
ADMINISTRATOR:	UNICE YOUNG		FACILITY TYPE:	735
ADDRESS:	16317 MCKINLEY AVE		TELEPHONE:	(310) 486-9030
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	4	CENSUS: 3	DATE:	10/10/2024
		UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Unice Young		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility violated their fire clearance.
Facility staff restrain clients with their clothing to prevent behaviors.
Facility staff speak inappropriately to clients in care.
Facility staff force clients to remain in their rooms.
Facility staff are providing expired food to clients.
Administrators certificate is expired.
Facility staff mismanaged the facility medication log.
Facility does not make toxins inaccessible to clients.
Facility failed to meet clients need.

INVESTIGATION FINDINGS:

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On 10/02/24, at 9:26am, Licensing Program Analyst (LPA) Perry Scott conducted an initial unannounced visit to the facility and was greeted by Unice Young, Director (S1). LPA explained the purpose of this visit is to gather information pertaining to the complaint allegations, conduct interviews, gather facility files, and take a tour the facility.

The investigation consisted of the following: LPA investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and clients (C1-C3). Client Roster (Dated: 05/20/2002) Staff Roster (Dated: 01/2024), ID/Emergency Information (Dated: 07/22/2016, 03/06/2013, & 02/06/2013) Physicians Report (Dated: 04/19/2024, 04/05/2024) Individual Service Plan (Dated: 02/01/2024), Face Sheet (Dated: 06/13/2023, 08/19/2019, & 12/20/2020), Ambulatory Statement (Dated: 07/05/2016, 08/19/2011, & 02/04/2013) Medication Administration Records (Dated: September & October 2024) and Client Development Evaluation Report (Dated: 02/08/2024) for clients (C1-C3)...

Report continued LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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 6

Control Number 11-AS-20240923094104

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 HOUSE	FACILITY NUMBER: 198601343
	VISIT DATE: 10/10/2024

NARRATIVE

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and Personnel Report (Dated: 08/01/2023), Criminal Record Statement (Dated: 08/01/2023), First Aid Certificate (Dated: 04/08/2023), Health Screening Report (Dated: 01/23/2024), Designation of Facility Responsibility (Dated: 10/02/2024), and Administrator Certificate (Dated: 04/25/2024-01/16/2026) for staff were obtained from the facility.
The investigation revealed the following: Allegation #1- Facility violated their fire clearance.

The details of the complaint alleged that the facility violated their fire clearance by having a non-ambulatory client in a facility that was only fire clearance cleared for ambulatory clients. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) and clients (C1-C3) regarding the allegation. 4 of 4 staff denied the allegation that the Facility violated their fire clearance. All staff (S1-S4) stated that all clients in the facility are ambulatory, and that they have never violated the fire clearance by having a non-ambulatory client in care.

LPA interviewed clients C1-C3 about the allegation and 3 of 3 clients denied the allegation that the Facility violated their fire clearance. All clients verified that they could walk without assistance. LPA observed that all clients (C1-C3) were able to ambulate without assistance from staff. LPA further observed that (C1-C3) were able to ambulate from the facility van where they were returning from their day program, and ambulate into the facility, into their bedrooms, and move around the facility without staff intervening to help with assistance. LPA reviewed Ambulatory Statements (Dated: 07/05/2016, 08/19/2011, & 02/04/2013) and Physicians Reports (Dated: 04/19/2024, 04/05/2024) for clients (C1-C3) that shows that all clients in the facility are ambulatory.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility violated their fire clearance. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation #2- Facility staff restrain clients with their clothing to prevent behaviors.

The details of the complaint alleged that the facility staff and the administrator tie the consumer's (C1) long-sleeved PJ over C1s hand during sleep hours to prevent C1 from skin picking during C1s sleep. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) and clients (C1-C3) regarding the allegation. 4 of 4 staff denied the allegation that Facility staff restrain clients with their clothing to prevent behaviors.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 11-AS-20240923094104

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 HOUSE	FACILITY NUMBER: 198601343
	VISIT DATE: 10/10/2024

NARRATIVE

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All staff (S1-S4) stated that they have never restrained clients with their clothing to prevent behaviors. Staff stated that C1 tends to pick at C1s skin until C1 breaks the skin. To prevent the skin from getting infected staff applies antibiotic cream and uses gauze to bandage the hand or arm, stated staff, so that the broken skin may heal. LPA reviewed C1s Individual Service Plan (Dated: 02/01/2024), that states C1 needs constant supervision in order to prevent C1 from harming C1s self as C1 frequently engages in self-injurious behavior. This includes head-banging, hitting, biting, and scratching C1s self or otherwise acting to cause C1 harm. LPA also reviewed C1s Physicians Report (Dated: 04/05/2024) that states C1 has behaviors of yelling, hitting, and self-injurious behaviors.

LPA interviewed clients C1-C3 about the allegation and 2 of 3 clients that were interviewed denied the allegation that the Facility staff restrain clients with their clothing to prevent behaviors. C1 could not participate fully in the interview process because of cognitive difficulties. Clients that were interviewed stated that the staff does not restrain them with their clothing to prevent behaviors. LPA observed that C1 has old scars on hands and arms that has healed.

Based on interviews, observation, and records reviewed, there is insufficient evidence to support the allegation that the Facility staff restrain clients with their clothing to prevent behaviors. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation #3- Facility staff speak inappropriately to clients in care.

The details of the complaint alleged that the administrator uses profanity toward the consumers daily. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) and clients (C1-C3) regarding the allegation. 4 of 4 staff denied the allegation that Facility staff speak inappropriately to clients in care. All staff (S1-S4) interviewed stated that none of the staff uses inappropriate language around the clients or profanity that is directed specifically at them. Staff stated that this has never happened to their knowledge. S1 stated that at no time has S1 ever used profanity at the clients in care.

LPA interviewed clients C1-C3 about the allegation and 2 of 3 clients that were interviewed denied the allegation that Facility staff speak inappropriately to clients in care. C1 could not participate fully in the interview process because of cognitive difficulties. Clients that were interviewed stated that the staff does not use inappropriate language towards them or others in care.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 11-AS-20240923094104

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 HOUSE	FACILITY NUMBER: 198601343
	VISIT DATE: 10/10/2024

NARRATIVE

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Based on interviews, there is insufficient evidence to support the allegation that the Facility staff speak inappropriately to clients in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation #4- Facility staff force clients to remain in their rooms.

The details of the complaint alleged that the administrator makes them stay in their rooms most of the time because they have laptops, TVs, and things to entertain themselves. They only come out of their room if they are called for medication, meals, etc. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) and clients (C1-C3) regarding the allegation. 4 of 4 staff denied the allegation that Facility staff force clients to remain in their rooms. All staff (S1-S4) state that the clients are not forced to stay in their rooms and that this is their home, they are free to move throughout it without constraints. At no time, stated (S1) has any of S1s clients been forced to stay in their rooms; that has never happened, stated S1.

LPA interviewed clients C1-C3 about the allegation and 2 of 3 clients that were interviewed denied the allegation that the Facility staff force clients to remain in their rooms. C1 could not participate fully in the interview process because of cognitive difficulties. Clients that were interviewed stated that the staff has never forced them to stay in their room. And that they are satisfied with their care and supervision.

Based on interviews, there is insufficient evidence to support the allegation that the Facility staff force clients to remain in their rooms. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation #5- Facility staff are providing expired food to clients.

The details of the complaint alleged that the facility has expired food in the facility and garage. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) and clients (C1-C3) regarding the allegation. 4 of 4 staff denied the allegation that Facility staff are providing expired food to clients. All staff (S1-S4) state that they have not served any expired food to the clients. They state that before food is served, they check that the food is not expired and have a system in place to check for expired food periodically. LPA observed the can goods in the facility and garage as well as the perishable food in the refrigerator and freezers and did not observe any expired foods. LPA also observed that the garage is organized and does not have any hazards or obstructions.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 11-AS-20240923094104

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 HOUSE	FACILITY NUMBER: 198601343
	VISIT DATE: 10/10/2024

NARRATIVE

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LPA interviewed clients C1-C3 about the allegation and 2 of 3 clients that were interviewed denied the allegation that the Facility staff are providing expired food to clients. C1 could not participate fully in the interview process because of cognitive difficulties. Clients that were interviewed stated that the staff has never served them expired food and that the food they receive tastes good and smells good.

Based on interviews and observation, there is insufficient evidence to support the allegation that the Facility staff are providing expired food to clients. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation #6- Administrators certificate is expired.

The details of the complaint alleged that the administrator certificate has expired. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff confirmed the allegation that the Administrators certificate is expired. All staff state that although the administrator’s certificate has expired the administrator (S1) appointed another staff member to be the administrator until S1 has renewed S1s certificate. S1 verified that S1s certificate has expired and that S1 is in the process of renewing their certificate.

S1 stated that S1 has appointed, in the interim, another staff member that has the required documents and an administrator’s certificate to be the administrator until S1 has renewed their certificate. LPA observed that the administrator’s (S1) certificate has expired and observed that S1 has appointed another staff member as administrator with a valid certificate that expires on 01/16/2026 and is on the current personnel roster as the back-up administrator. LPA reviewed the current administrator of the facility and observed that the staff member has the required documents to be an administrator.

Based on interviews, observation, and records reviewed, there is sufficient evidence to support the allegation that the Administrators certificate is expired. However, the licensee has appointed another staff member as interim administrator, until their certificate has been renewed, therefore the allegation is Unsubstantiated.

Allegation #7- Facility staff mismanaged the facility medication log.

The details of the complaint alleged that the administrator asks for extra Medication Administration Records (MARs) from the pharmacy to cover up for any medication errors. It is reported that the administrator will redo the (MARs) and have the staff initial and sign again. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that the Facility staff mismanaged the facility medication log.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20240923094104

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 HOUSE	FACILITY NUMBER: 198601343
	VISIT DATE: 10/10/2024

NARRATIVE

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Staff (S1) stated that S1 has not mismanaged the MAR or had any of S1s staff to sign again to cover up any errors that have occurred. Staff (S2-S4) stated that at no time has the administrator (S1) asked them to sign again on a new MAR because of any medication error that may have occurred. LPA reviewed the medication administration records (Dated: September & October 2024) and did not find any discrepancies.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility staff mismanaged the facility medication log. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation #8- Facility does not make toxins inaccessible to clients.

The details of the complaint alleged that the facility staff does not ensure that the toxins are locked up in the facility or garage and inaccessible to clients. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that the Facility does not make toxins inaccessible to clients. All staff (S1-S4) stated that the toxins and sharps are always locked after each use and at no time do the clients have access to toxins or sharps. LPA observed on an unannounced visit to the facility, that all cabinets that has sharps, toxins, and medication were locked and incompliance with Title 22 regulations.

Based on interviews and observation, there is insufficient evidence to support the allegation that Facility does not make toxins inaccessible to clients. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation #9- Facility failed to meet clients need.

The details of the complaint alleged that the facility does not have enough staff to support the needs and services for the consumers. On 10/02/24, from 09:30am-2:00pm, LPA interviewed staff (S1-S4) and clients (C1-C3) regarding the allegation. 4 of 4 staff denied the allegation that the Facility failed to meet clients need. All staff (S1-S4) stated that there is enough staff to meet the needs of the clients. S1 stated that there are two staff working during the day to take care of three clients and one staff working the overnight shift. LPA observed the personnel roster and verified that the facility has six (6) employees in addition to the licensee that are scheduled to work the day and night shift; and have enough coverage to meet the needs of the clients.

LPA interviewed clients C1-C3 about the allegation and 2 of 3 clients that were interviewed denied the allegation that the Facility failed to meet clients need. C1 could not participate fully in the interview process because of cognitive difficulties. Clients that were interviewed stated that they were satisfied with the care and supervision they are getting from the staff. They also stated that they feel there is enough staff to meet their needs.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility failed to meet clients need. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited for this complaint.

An exit interview was conducted with Unice Young, Director, and a hard copy of the Complaint Investigation Report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

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