366413073-11-1-2022-18-AS-EMAN-CLN2PR-20221129163445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413073
Report Date: 11/01/2022
Date Signed: 11/01/2022 03:54:45 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
03/03/2021 and conducted by Evaluator Natalie Ibarra

COMPLAINT CONTROL NUMBER: 18-AS-20210303152015

FACILITY NAME:	HERITAGE COURT ASSISTED LIVING		FACILITY NUMBER:	366413073
ADMINISTRATOR:	SCHLOTTMAN, JACOB		FACILITY TYPE:	740
ADDRESS:	275 GARNET WAY B		TELEPHONE:	(909) 204-5000
CITY:	UPLAND	STATE: CA	ZIP CODE:	91786
CAPACITY:	88	CENSUS:	DATE:	11/01/2022
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Erika Montoya		TIME COMPLETED:	04:03 PM

ALLEGATION(S):

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Staff did not assist resident with medications as needed.
Facility did not coordinate care with hospice agency.
Staff did not meet resident's bathing needs.
Facility is malodorous.
Facility is not clean.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Natalie Ibarra and Victoria Chitgian made an unannounced visit to the facility to deliver findings for the above allegations. LPAs met with assistance administrator Erika Montoya and explained the purpose fo today's visit. The investigation consisted of interviews with pertinent parties and records review

The first allegation indicates staff did not assist resident with medications as needed. Interiviews with Staff #1 (S1) and Staff #2 (S2) indicated that Resident #1 (R1) medications were being administered. LPAs reviewed medication log for R1 and observed medications were being administered to R1 including eye drops and topical creams prescribed by doctor. S4 stated hospice company would provided lot of topical creams and eye drops at once due to bottles being small

The second allegation indicates facility did not coordinate care with hospice agency. Interviews with S1 and S2 stated facility was coordinateing with hospice facility. S4 stated facility is always in communication with hospice. Interview with Bridge Hospice Executive Director stated that per visit notes facility was coordinating care with hospice.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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 18-AS-20210303152015

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 COURT ASSISTED LIVING	FACILITY NUMBER: 366413073
	VISIT DATE: 11/01/2022

NARRATIVE

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The third allegation indicates staff did not meet resident's bathing needs. Interviews with S1, S2, S3, and S4 stated that when a resident is on hospice, hospice will take over bathing residents. S2 and S4 stated baths were being administered by hospice company. Interview with Bridge Hospice Executive Director stated baths were being provided per aid nurse notes. LPA review aide care notes from Bridge Hospice that stated complete bed baths were to be done every visit per instructions.

The fourth allegation indicates facility is malodorous. LPAs Ibarra and Chitgian toured the facility, including a sample of resident rooms, common restrooms, activity room , and dining area. LPAs did not observe any foul odors. Interviews with S1 and S3 denied facility is odoriferous

The fifth allegation indicates facility is not clean. LPAs Ibarra and Chitgian toured the facility, including a sample of resident rooms, common restrooms, activity room , and dining area. LPAs did not observe facility to be unclean. Interviews with S1 and S3 denied facility is not kept clean.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was discussed and provided to Assistant Administrator Erika Montoya.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

LIC9099 (FAS) - (06/04)

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