306003908-6-2-2023-11-AS-UCOL-D4PSA9-20240426134158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003908
Report Date: 06/02/2023
Date Signed: 06/02/2023 01:33:08 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
05/30/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20230530101859

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: 11	DATE:	06/02/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMINISTRATOR MARY CRUZ		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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9

Financial Abuse

INVESTIGATION FINDINGS:

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13

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Heritage Board & Care #3 on 06/02/2023 and was greeted by Administrator Mary Cruz (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

During this investigation, LPA Calderon interviewed A1, S1, C1-C3. C4-C11 are at day program and could not be interviewed. These interviews were conducted on 06/02/2023. On 06/02/2023 LPA Calderon requested copies of the following: Staff LIC500 and Client rosters, copy of C1 facility file, Copy of S2 facility file. Medication Administration Records (MAR) for C1-C4 for 6 months.

The investigation revealed the following:

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

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-20230530101859

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HERITAGE BOARD & CARE #3	FACILITY NUMBER: 306003908
	VISIT DATE: 06/02/2023

NARRATIVE

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Regarding Allegation #1: Financial Abuse.

The alleged staff did not give C1 April and May P&I money. A1 relays that A1 did have conversation with Mental Health America of Los Angeles (MHALA) staff and advised that C1 P&I money for April and May 2023 had gone missing and the facility would reimburse MHALA the $800.00 funds. A1 relays that A1 does not believe any other clients funds have gone missing. On 06/02/2023 LPA Calderon interviewed C1-C3 for complaint. C1 passed away on 05/24/2023 and could not be interviewed. C2 relays that C2 gets money from SSI and staff has never refused to give him his P&I money when he asks for the money. C3 relays that staff told C3 that he had to wait for 2 weeks as C3 check had not been deposited by the bank. C3 relays that when he did have money in C3 account staff gave C3 money when C3 asked for the money.

Based on LPA Calderon observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation “financial Abuse” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 are being cited on the attached LIC 9099D.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator Mary Cruz (A1).

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 11-AS-20230530101859

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HERITAGE BOARD & CARE #3	FACILITY NUMBER: 306003908
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/09/2023 Section Cited CCR 80026(b)	1 2 3 4 5 6 7	80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents; B: If such a client is accepted for or maintained in care, his/her cash resources, personal property...This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee to refund MHALA $800.00 dollars by 06/09/2023 and email LPA Calderon copy of refund check
	8 9 10 11 12 13 14	Based on interviews, observations and records review the licensee did not safeguard clients P&I money.This poses a potential health & safety risk to clients regarding their money.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
05/30/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20230530101859

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: 11	DATE:	06/02/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMINISTRATOR MARY CRUZ		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Failure to give medication to client as prescribed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
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13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

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-20230530101859

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HERITAGE BOARD & CARE #3	FACILITY NUMBER: 306003908
	VISIT DATE: 06/02/2023

NARRATIVE

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3
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Regarding Allegation #1: Failure to give medication to client as prescribed.

The alleged staff did not give C1 medication as prescribed. On 06/02/2023 LPA Calderon interviewed A1 for complaint. A1 relays that S1 is given training on how to distribute the medication to clients that live at the facility. A1 relays that S1 keeps records of all 11 clients regarding what medication was taken and if the client refused to take the medications. A1 relays that S1 is the only staff that gives medications to clients and S1 keeps track on the clients MAR of what medication was given. On 06/02/2023 LPA Calderon interviewed S1 for complaint. S1 relays that S1 passes out medications to all 11 clients 3 or 4 times per day and S1 relays that he updates the MAR and the medication logbook for clients that refuse to take the medications or are not in the facility to take their medication. On 06/02/2023 LPA Calderon could not take C1 statement as C1 had passed away on 05/24/2023. On 06/02/2023 LPA Calderon interviewed C2-C3 for complaint. C2-C3 relays that staff give them their medication 3 times per day and staff has never missed or refused to give clients their medications as prescribed. On 06/02/2023 LPA Calderon attempted to take C4-C11 statements, but C4-C11 are at day program and could not be interviewed. On 06/02/2023 LPA Calderon reviewed MAR for C1-C4. LPA Calderon reviewed MAR for C1-C4 and could not find any issues with MAR reports.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegation of “Failure to give medication to client as prescribed” is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator Mary Cruz (A1).

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5