336426688-7-24-2024-56-AS-KCLS-D8JL8H-20240827083157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426688
Report Date: 07/24/2024
Date Signed: 07/24/2024 11:43:29 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
05/02/2024 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240502114053

FACILITY NAME:	HEARTLAND MANOR		FACILITY NUMBER:	336426688
ADMINISTRATOR:	AHMED QASIM		FACILITY TYPE:	740
ADDRESS:	178 W. PENDLETON ROAD		TELEPHONE:	(951) 849-7750
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	22	CENSUS: 16	DATE:	07/24/2024
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Amirr Younes - House Manager		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff left resident on the floor
Staff had resident sign documents without notifying resident's responsible party
Staff raised resident's rent without notifying resident's responsible party

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint investigation on the above allegations. LPA met with House Manager, Amirr Younes, who was informed of today’s visit.

Regarding the allegation, staff left resident on the floor, it was alleged that staff refused to assist resident #1 (R1) off the floor after a fall. Five (5) residents interviewed deny that staff have left them on the floor and have not witnessed staff leave other residents on the floor. R1 was not interviewed as they no longer reside at the facility. Four (4) staff interviewed deny leaving any residents on floor.

Regarding the allegation, staff had resident sign documents without notifying resident's responsible party, it was alleged that facility staff had R1 sign documents without notifying R1’s authorized Power of Attorney (POA). Staff #1 (S1) stated that R1 did not have an authorized POA on file. R1 was not interviewed as they no longer reside at the facility. LPA contacted an outside party requesting POA documents and no documents were provided to the LPA.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

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-20240502114053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HEARTLAND MANOR	FACILITY NUMBER: 336426688
	VISIT DATE: 07/24/2024

NARRATIVE

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Regarding the allegation, staff raised resident's rent without notifying resident's responsible party, it was alleged that facility staff did not notify R1’s authorized Power of Attorney (POA) of a rent increase. S1 stated that R1 did not have an authorized POA on file. R1 was not interviewed as they no longer reside at the facility. LPA contacted an outside party requesting POA documents and no documents were provided to the LPA.

Based on record review and interviews, the allegations are Unsubstantiated; an Unsubstantiated finding means that 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.

An exit interview was conducted and a copy of this report was provided with Appeal Rights to the House Manager at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC9099 (FAS) - (06/04)

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