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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601343
Report Date: 07/31/2025
Date Signed: 07/31/2025 02:07:30 PM

Substantiated


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
07/23/2025 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250723103240
FACILITY NAME:HERITAGE HOUSEFACILITY NUMBER:
198601343
ADMINISTRATOR:ROSIE LEWISFACILITY TYPE:
735
ADDRESS:16317 MCKINLEY AVETELEPHONE:
(310) 486-9030
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:4CENSUS: 3DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
09:29 AM
MET WITH:Unice YoungTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee did not ensure a qualified administrator was present at the facility.
INVESTIGATION FINDINGS:
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On 7/31/25, at 09:30am, the department conducted an initial complaint visit to the facility and was greeted by Unice Young, Director. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff, and deliver findings for the allegation mentioned above.

The investigation consisted of the following: The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1) from 9:30am-2:30pm. The department received the following documents: Administrator packet (Designation of Facility Responsibility LIC308, Personnel record LIC501, Criminal Record statement LIC508, Health Screen Report LIC 503, Personnel Report LIC 500, Emergency Disaster Plan LIC 610, and Administrator Certificate from the facility.

The investigation revealed the following: Allegation-Licensee did not ensure a qualified administrator was present at the facility.

Report Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
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-20250723103240
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: 07/31/2025
NARRATIVE
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The details of the complaint alleged that the licensee did not ensure a qualified administrator was present at the facility and did not appoint a new administrator or submit a new administrator packet to Community Care Licensing (CCLD) within thirty days after the former administrator left the position. On 7/31/25, from 9:30am-2:30pm, the department interviewed staff (S1) regarding the allegation. 1 of 1 staff corroborated the allegation and stated that there was a previous administrator between September 2024 through June of 2025, after the prior administrator left, but they failed to submit any paperwork to CCLD letting the department know of the change and to remove the prior administrator from the record. S1 stated that they have hired a new administrator and have the required documents to turn into CCLD and they will appoint them as the new administrator of record until they receive their administrator certificate from the Administrator Certification Bureau.

The department reviewed the new administrator packet (Designation of Facility Responsibility LIC308, Personnel record LIC501, Criminal Record statement LIC508, Health Screen Report LIC 503, Personnel Report LIC 500, Emergency Disaster Plan LIC 610, and Administrator Certificate for the present administrator and observed that they had a qualified administrator to be appointed, and the documents will be processed by CCLD to update the record. The department verified with the Administrator Certification Bureau that the licensee has applied on 06/26/2025 to renew their administrator certificate.

Based on observation, interviews conducted, and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation Licensee did not ensure a qualified administrator was present at the facility, is found to be Substantiated. The facility failed to officially appoint a new administrator and submit the required documents to CCLD within 30 days as required by Title 22, which poses a potential health and safety risk. California Code of Regulations, Title 22, Division (6) and chapter (6) section 85061(b) (1-3) for reporting requirements are being cited on the attached LIC 9099D.

Note: *Citations that are not cleared by the due date of 07/31/2025 will have a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared.

Deficiencies are issued and plans of corrections were discussed. Citation was cleared during the complaint visit.

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

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250723103240
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2025
Section Cited
CCR
85061(b)(1-3)
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85061(b) (1-3) Reporting Requirements (b) The licensee shall notify the licensing agency, in writing, within 30 days of a change of administrator. Such notification shall include the following: (1) Name, and residence and mailing addresses of the new administrator. (2) Date he/she assumed his/her position. (3) Description of his/her background and qualifications, including documentation of required education and certification. This requirement is not met as evidenced by:
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The Licensee will adhere to Title 22 regulations 85061(b) (1-3) and submit the required documents to update the current administrator for the facility. The following documents are needed: LIC308, LIC501, LIC508, Administrator Certificate, first aid card, LIC503, LIC610, and current LIC500 with new administrator listed. All documents shall be submitted by POC date of 07/31/25 to avoid monetary penalties. Licensee cleared citation on today’s visit.
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Based on interview and record review, the licensee did not comply with the section cited above for a previously employed administrator, by not informing CCLD of the change and not submitting the required documents, which poses 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: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3