360900455-8-7-2023-56-AS-KCLS-CV2NFU-20230825102608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360900455
Report Date: 07/13/2023
Date Signed: 08/07/2023 11:09:28 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/10/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230710091048

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: 46	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lisa Leak Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility is in disrepair
Residents are wearing dirty clothing
Food served is not of good quality

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the mentioned allegations. LPA Allen met with assistant Administrator Tiurma Sihotang who was informed of the visit. The administrator Lisa Leak arrived shortly after.
LPA Allen conducted interviews with (5) five residents, (4) four staff members and (1) one outside party.
The interviews conducted with 4 staff members and 5 residents stated that the dryer has been out of order for about two weeks and their cloths have been washed in the washer but have been hung to dry or taken to another location to dry clothes. Documents were provided by the administrator showing a scheduled repair date of the dryers for 7/17/20.

LPA toured the facility and in hallway #1 the temperature thermostat was 80-84 degrees and LPA observed two fans operating in hallway #1. LPA toured some of the bedrooms in hallway #1 and residents had their personal fans or wall ac units on. LPA asked residents about the temperature and the residents said they didn’t have any complaints about their rooms just the hallway area.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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-20230710091048

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: HERITAGE GARDENS	FACILITY NUMBER: 360900455
	VISIT DATE: 07/13/2023

NARRATIVE

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LPA interviewed 2 staff members and 1 one outside party who confirmed that an appointment is scheduled for 7/14/2023 to access problem with the air conditioning unit in hallway #1 to determine if it needs to be replaced or repaired. Once the visit is completed a copy of the invoice/service needs will be provided to CCL.

LPA Allen conducted interviews with (5) five residents and they said that they are provided with nutritious meals and snacks throughout the day. There were 3 three menus available and alternate options available for the residents. LPA also observed documentation to shows if there is a special request for preparation of a food item it done in advance by the resident to ensure that their request is met. LPA toured the kitchen and there was a variety of food items available. There was a 7day supply of non-perishable food items and 5 days of perishable food items. The facility was toured inside and out and there were no health and safety concerns.

Based on the interviews conducted with the 5 five resident, 4 four staff members, 1 outside party and documents reviewed the above allegations are Unsubstantiated. A finding of unsubstantiated means although the allegations 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 with Lisa Leak and a copy was provided with the appeal rights at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

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