336426688-10-2-2023-56-AS-EMAN-CWZNBR-20231027101933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426688
Report Date: 10/02/2023
Date Signed: 10/02/2023 12:34:25 PM

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
05/30/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230530155755

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: 21	DATE:	10/02/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Amirr Younes, Manager		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Resident in care is using methamphetamine
Staff did not ensure resident's hygiene needs were met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to deliver findings on the above-mentioned allegations. LPA met with Amirr Younes, Manager and discussed the purpose of the visit.
Regarding the allegation, resident in care is using methamphetamine, the Department’s investigation consisted of pertinent record review and interviews with relevant parties. The Department interviews with staff and residents deny witnessing Resident #2 (R2) abusing narcotics. Interviews revealed that facility staff contacted Banning Police Department and reported R2 for suspected drug abuse. The Department has determined the allegation to be Unsubstantiated.

Regarding the allegation, staff did not ensure resident's hygiene needs were met, LPA observed the facility has sufficient personnel hygiene supplies, which included toothpaste, soap, and shampoo for residents in care. Staff interviews deny not ensuring resident’s hygiene needs are met. Ten (10) residents interviewed stated that their hygiene needs are being met.

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: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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-20230530155755

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: 10/02/2023

NARRATIVE

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Based on LPA observations, record review and interviews with relevant parties, the allegation is Unsubstantiated.
Unsubstantiated meaning 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 where reports (LIC9099/LIC9099-C/LIC9102) were discussed, and copies with appeal rights were provided to Manager Younes 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: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

LIC9099 (FAS) - (06/04)

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