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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003908
Report Date: 06/13/2022
Date Signed: 06/13/2022 01:34:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/25/2021 and conducted by Evaluator Jade Jordan
COMPLAINT CONTROL NUMBER: 11-AS-20210525144718
FACILITY NAME:HERITAGE BOARD & CARE #3FACILITY NUMBER:
306003908
ADMINISTRATOR:WARREN TRINIDADFACILITY TYPE:
735
ADDRESS:2900 E. 7TH STREETTELEPHONE:
(562) 434-1588
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:18CENSUS: 13DATE:
06/13/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Mary Grace TrinidadTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Neglect/Lack of Supervision-Residents are using illegal drugs under the care and supervision of the facility.

INVESTIGATION FINDINGS:
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On 06/13/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced subsequent visit regarding the allegation(s) above. LPA was met by Facility Administrator, and the purpose of the visit was explained. This is a continued investigation from complaint dated 05/25/21.

Investigation Consisted of: Physical Plant Tour, Interviews conducted with staff, residents, reporting party, and pertinent documentation was obtained related to the investigation. Service Request was made and Accepted as full Investigation to Department Investigation Branch.

Regarding Allegation: Neglect/Lack of Supervision-Residents are using illegal drugs under the care and supervision of the facility

The Departments Investigations Branch revealed interviews conducted with a witness captured on video, residents using (smoking) some type of drug, in front of their residence.
*************Continued on 9099 C*********************************************
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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 5
Control Number 11-AS-20210525144718
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HERITAGE BOARD & CARE #3
FACILITY NUMBER: 306003908
VISIT DATE: 06/13/2022
NARRATIVE
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Interviews conducted with clients revealed that, there are clients who use drugs inside, and outside of the facility. Interviews conducted with Staff members revealed that, they are aware of client drug use, and have witnessed clients using drugs, and purchasing drugs on the premises of the facility, and outside of the facility. Interviews were conducted with (4) staff personnel, (6) clients, and 1 witness. IB investigator also obtained photo copies, of drug paraphernalia within the facility. According to facility house rules, #4 drug use is not allowed.

Based on observations, record review and interviews; The preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code Of Regulations, (Title 22, Division 6, Chapter #1), are being cited on the attached LIC 9099 D.”)

An Exit interview was conducted. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/25/2021 and conducted by Evaluator Jade Jordan
COMPLAINT CONTROL NUMBER: 11-AS-20210525144718

FACILITY NAME:HERITAGE BOARD & CARE #3FACILITY NUMBER:
306003908
ADMINISTRATOR:WARREN TRINIDADFACILITY TYPE:
735
ADDRESS:2900 E. 7TH STREETTELEPHONE:
(562) 434-1588
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:18CENSUS: 13DATE:
06/13/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Mary Grace Trinidad TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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 Neglect/Lack of Supervision- Staff is not preventing inappropriate interactions,
Inappropriate behaviors resulting in resident injury.
INVESTIGATION FINDINGS:
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On 06/13/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced subsequent visit regarding the allegation(s). LPA was met by Facility Administrator, and the purpose of the visit was explained.

Investigation Consisted of: Physical Plant Tour, Interviews conducted with staff, residents, reporting party, and pertinent documentation was obtained related to the investigation. Service Request was made and Accepted as full Investigation to Department Investigation Branch.

Regarding Allegation(s): : Neglect/Lack of Supervision- Staff is not preventing inappropriate interactions, and inappropriate behaviors resulting in resident injury.

It is alleged that In April of 2021 Resident 1 (R1) was attacked resulting in an injury. R1 declined to be interviewed regarding the allegation. Resident 2 (R2) indicated that an unidentified person stabbed R1 through an open window, twice in the head, and once in the arm.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20210525144718
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HERITAGE BOARD & CARE #3
FACILITY NUMBER: 306003908
VISIT DATE: 06/13/2022
NARRATIVE
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Resident 2 (R2) witnessed the incident but could not identify the attacker. Investigation later revealed that the alleged attacker who was later seen on video outside of the facility, was a former resident. Administrator interviews indicated that the former resident seen on tape, had been previously moved to their sister facility due behaviors worsening. Investigation Branch investigator finds that the way the incident occurred; staff could not have prevented it.

Based on Observation, Record Review, and Interviews the Department finds” Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”


An exit interview conducted, and a copy of this report was provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20210525144718
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HERITAGE BOARD & CARE #3
FACILITY NUMBER: 306003908
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2022
Section Cited
HSC
80078(a)
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 80078(a) Responsibility for Providing Care and Supervision
(a)The licensee shall provide care and supervision as necessary to meet the client's needs. This standard was not met, as evidenced by: Admittance of observation of drug use; and drug paraphernaila in the facility. This poses an immediate health, safety, personal rights risk to residents in care.


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Effective Immediately Licensee will Provide Training to staff regarding observation of drug to follow house rules; All Residents shall be issued written warnings for drug use observed.
Copy of inservice training with topic and employee names shall be provided by POC Due date 06/14/22 to be emailed to LPA Jordan at Jade.Jordan@dss.ca.gov
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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: Ulysses Coronel
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5