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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003908
Report Date: 04/24/2024
Date Signed: 04/24/2024 02:55:23 PM

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
04/16/2024 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20240416112839
FACILITY NAME:HERITAGE BOARD & CARE #3FACILITY NUMBER:
306003908
ADMINISTRATOR:WARREN TRINIDADFACILITY TYPE:
735
ADDRESS:2900 E. 7TH STREETTELEPHONE:
(562) 900-6261
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:18CENSUS: 13DATE:
04/24/2024
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Administrator Mary CruzTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff made inappropriate comments towards client.
Staff was harassing client.
INVESTIGATION FINDINGS:
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On 04/24/24 at 09:00 a.m., Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegations above. LPA met with Administrator Mary Cruz as the purpose of today’s visit was explained.

The investigation consisted of the following: On 04/24/24 LPA Villegas requested copies of the following: Staff and client rosters, visitiation policy, personal rights form and the following forms for Clients # 1-3 (C1-C3); Facehseet, admission agreement, physicians report, medication list, needs and service plan, personal rights form, and conservatorship paperwork for C1. On 04/24/24 LPA interviewed C1, C4, C5, C6, C7, A1, S1-S3, and W1.

Allegation: Staff made inappropriate comments towards clienyt.
It is being alleged that facility staff called a client in care craz. On 04/24/24 LPA interviewed A1 regarding the allegation above, A1 denied the allegation and reported that no inappropriate comments have been
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
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 2
Control Number 11-AS-20240416112839
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 BOARD & CARE #3
FACILITY NUMBER: 306003908
VISIT DATE: 04/24/2024
NARRATIVE
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made to any client in care as the clients are like family. On 04/24/24 LPA interviewed S1-S3 regarding the allegation above, 3 of 3 staff interviewed denied the allegation and reported no negative comments have been made. On 04/24/24 LPA interviewed C1 and C4-C7 regarding the allegation above, 5 of 5 clients interviewed denied the allegation above and reported having good interactions with staff. On 04/24/24 LPA spoke to W1 regarding the allegation above, W1 reported not having any concerns at this time regarding the care being provided.

Allegation: Staff was harassing client.
It is being alleged that facility staff is harassing client during visitation. On 04/24/24 LPA interviewed A1 regarding the allegation above, A1 denied the allegation above and reported that visitations are encouraged and that staff are aware not interrupt a client who has a visitor. Per A1 visitation takes place in the common areas or in the gazebo located in the backyard. On 04/24/24 LPA interviewed S1-S3 regarding the allegation above, 3 of 3 staff interviewed denied the allegation and reported that clients are left alone with their visitors without interruption. On 04/24/24 LPA interviewed C1 and C4-C7 regarding the allegation above, 5 of 5 clients interviewed denied the allegation above and reported having enough privacy at the facility. On 04/24/24 LPA interviewed W1 regarding the above allegation, W1 reports W1 has enough privacy when visiting the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2