336407790-5-16-2025-56-AS-KCLS-DGWS6V-20250522133635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407790
Report Date: 05/16/2025
Date Signed: 05/16/2025 10:43:32 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/30/2023 and conducted by Evaluator Eldin Serrano

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231030124204

FACILITY NAME:	HERITAGE RESIDENTIAL CARE		FACILITY NUMBER:	336407790
ADMINISTRATOR:	MARIA ARACELI UNDAN		FACILITY TYPE:	740
ADDRESS:	20975 MARIPOSA ROAD		TELEPHONE:	(951) 245-0892
CITY:	LAKE ELSINORE	STATE: CA	ZIP CODE:	92530
CAPACITY:	6	CENSUS: 6	DATE:	05/16/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Maria Araceli Undan, Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not ensure that resident was adequately fed.
Staff did not meet resident's grooming needs.

INVESTIGATION FINDINGS:

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On 5/16/2025 at 9:30 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Serrano met with Administrator Maria Araceli Undan to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staffs and residents as well as facility observation.

Allegation #1: Staff did not ensure that resident was adequately fed.– Based on interviews 3 out 3 residents stated that they get enough food to fill them up and if they want more food, they can always ask for more. The residents stated that they were never denied food if they want to eat. Also, information received indicated that resident #1 (R1) was receiving additional services from an outside source from at least 7/07/2023 through 10/27/2023. Information received during investigation did not corroborate with the allegation.

*** Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Eldin Serrano	TELEPHONE: 951-248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20231030124204

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HERITAGE RESIDENTIAL CARE	FACILITY NUMBER: 336407790
	VISIT DATE: 05/16/2025

NARRATIVE

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Allegation #2: Staff did not meet resident's grooming needs. - Based on interviews 3 out of 3 residents stated that the facility staff helped them with showers and grooming. The residents stated that they have schedule and have no issues if help is needed. Also, information received indicated that resident #1 (R1) was receiving additional services from an outside source from at least 7/07/2023 through 10/27/2023. These services included showers and wound care. Information received during investigation did not corroborate that R1s grooming needs were not being met.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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 at this time.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Administrator Maria Araceli Undan.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Eldin Serrano	TELEPHONE: 951-248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

LIC9099 (FAS) - (06/04)

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