360900455-10-15-2024-56-AS-KCLS-DADVGK-20241025162539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900455
Report Date: 10/15/2024
Date Signed: 10/15/2024 03:48:38 PM

Unfounded

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
06/27/2024 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240627142625

FACILITY NAME:	HERITAGE GARDENS		FACILITY NUMBER:	360900455
ADMINISTRATOR:	LEAK, LISA		FACILITY TYPE:	740
ADDRESS:	25271 BARTON RD		TELEPHONE:	(909) 796-0219
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	64	CENSUS: 54	DATE:	10/15/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Sam Goings		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Staff did not ensure dinner was available to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Magda Malcore and Becky Mann conducted an unannounced visit to the facility to conclude the investigation on the above allegation. LPAs met with Sam Goings, Director of Operations, and explained the purpose of the visit. The investigation consisted of record review, interviews with staff and residents.

Regarding the allegation staff did not ensure dinner was available to resident in care, interviews with outside parties, five (5) staff and six (6) residents reveals, for every meal service, a meal ticket is created and placed along side a meal tray for each resident. Staff deliver the meal trays to the residents in their rooms or in the dining area. All residents interviewed stated that staff have not missed provided them with meal service.

Based on evidence obtained during the investigation, the above allegation is Unfounded. Unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted where this report was discussed and a copy provided to the Director of Operations at the conclusion of the visit.

Unfounded

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: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

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 3

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
06/27/2024 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240627142625

FACILITY NAME:	HERITAGE GARDENS		FACILITY NUMBER:	360900455
ADMINISTRATOR:	LEAK, LISA		FACILITY TYPE:	740
ADDRESS:	25271 BARTON RD		TELEPHONE:	(909) 796-0219
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	64	CENSUS: 54	DATE:	10/15/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Jessica Ramos		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Staff did not administer resident's medication as prescribed
Staff are allowing visitors to infringe in the rights of the residents
Unauthorized individual residing in resident's room

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Magda Malcore and Becky Mann conducted an unannounced visit to the facility to conclude the investigation on the above allegations. LPAs met with Sam Goings, Director of Operations, and explained the purpose of the visit. The investigation consisted of record review, interviews with staff and residents.

Regarding the allegation, staff did not administer resident's medication as prescribed, there is not enough evidence to corroborate the allegation. Five (5) staff interviewed deny not administering medications as prescribed. Five (5) out of (6) residents interviewed stated that staff do provide them their medication as prescribed.

Regarding the allegation, staff are allowing visitors to infringe in the rights of the residents, there is not enough evidence to corroborate the allegation. Five (5) staff interviewed deny allowing visitors to infringe in the rights of the residents. Five (5) out of (6) residents interviewed deny that visitors have infringed in their personal rights.

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: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

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

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 56-AS-20240627142625

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: HERITAGE GARDENS	FACILITY NUMBER: 360900455
	VISIT DATE: 10/15/2024

NARRATIVE

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Regarding the allegation, unauthorized individual residing in resident's room, there is not enough evidence to corroborate the allegation. Five (5) staff interviewed deny that unauthorized individual are sleeping and residing in residents’ rooms. Five (5) out of six (6) residents interviewed deny that unauthorized individuals are sleeping and residing in their rooms.
Based on evidence obtained during the investigation, the above allegations are Unsubstantiated. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted where this report was discussed and a copy of this report was provided with appeal rights to the Director of Operations 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: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

LIC9099 (FAS) - (06/04)

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