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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426688
Report Date: 10/02/2023
Date Signed: 10/02/2023 12:41:02 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
06/26/2023 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230626161439
FACILITY NAME:HEARTLAND MANORFACILITY NUMBER:
336426688
ADMINISTRATOR:AHMED QASIMFACILITY TYPE:
740
ADDRESS:178 W. PENDLETON ROADTELEPHONE:
(951) 849-7750
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:22CENSUS: 21DATE:
10/02/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Amirr Younes, ManagerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff are not providing a comfortable and safe environment for resident
Staff did not prevent residents from harassing another resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver investigation findings. LPA met with Amirr Younes, Manager and discussed the purpose of the visit.
Regarding the allegation, staff are not providing a comfortable and safe environment for resident, staff interviews deny not providing a comfortable and safe environment for the residents. In addition, staff stated that residents are told not to smoke in the facility. LPA observed facility rules which included a no smoking policy posted in a common area. Residents interviewed stated they feel safe and comfortable at the facility. In addition, residents stated they have not witnessed other residents smoking in the facility.
Regarding the allegation, staff did not prevent residents from harassing another resident, staff interviews deny not preventing resident harassment nor have they seen residents being harassed. Residents interviewed stated that they are not harassed by residents nor have they witnessed other residents being harassed.
Based on LPA observations, record review, interviews with pertinent parties, the allegations are Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 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)
Page: 1 of 2
Control Number 56-AS-20230626161439
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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A finding that is Unsubstantiated 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 where this report was discussed, and a copy of this report was provided to Manager, Younes at the conclusion of the visit.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 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)
Page: 2 of 2