306003908-8-3-2022-11-AS-JHAD-CJHU8G-20220922152130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003908
Report Date: 08/03/2022
Date Signed: 08/03/2022 01:34:13 PM

Unsubstantiated

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
07/27/2022 and conducted by Evaluator Jeremiah Randle

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220727095947

FACILITY NAME:	HERITAGE BOARD & CARE #3		FACILITY NUMBER:	306003908
ADMINISTRATOR:	WARREN TRINIDAD		FACILITY TYPE:	735
ADDRESS:	2900 E. 7TH STREET		TELEPHONE:	(562) 434-1588
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90804
CAPACITY:	18	CENSUS: 13	DATE:	08/03/2022
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Administrator Warren Trinidad		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility not providing a safe environment for resident(s) in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On or about 8/03/2022 9:30 a.m. Licensing Program Analyst (LPA) Jeremiah Randle and Licensing Program Manager (LPM) Janae Hammond conducted an unannounced complaint visit, regarding the allegations above. LPA was met by facility staff Maria Christina Rabang (S3), and later Administrator Warren Trinidad (S1) the purpose of the visit was explained.

Investigation Consisted of the following:

Client Interviews (C1-C9), Staff Interviews (S1-S4), Observation of Physical Plant, Record Review, and copies obtained of Pertinent documents pertaining to the allegation. LPA requested from the facility (Admissions Agreement, House Rules, Physicians Report /Medical Records, Client Roster, Staff Roster) Needs and Services, Functional Capability Assessment, SIR’s/SOC 341, staff / nursing notes and Police Reports if any. Resident(s) file(s) for Resident 1(victim) and Resident 2 (Alleged Aggressor) inclusive of all documents requested herein.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022

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 2

Control Number 11-AS-20220727095947

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: 08/03/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Investigation Revealed the following.

Regarding Allegation: Facility not providing a safe environment for resident(s) in care.

On 8/03/2022 LPA Randle interviewed Administrators SI and S2, both provided statements that they are unaware of any physical altercations between any residents named in the complaint, or between any other residents. LPA interviewed House Manager S4 and S3 both stated that they had not witnessed any resident altercations nor had any residents reported any altercations to them. LPA interviewed Clients C1-C9. Clients C1 and C2 declined to be interviewed with LPA, however LPA was able to interview Clients C3-C9 all clients confirmed that they had not witnessed any physical altercations between any residents.

LPA concluded interviews with residents and staff and reviewed records. Based on interviews and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED.

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

Exit interview held. A copy of the report was provided to Administrator Warren Trinidad

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2