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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413073
Report Date: 11/22/2022
Date Signed: 11/22/2022 11:19:13 AM

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
11/18/2022 and conducted by Evaluator Ryan Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20221118090320
FACILITY NAME:HERITAGE COURT ASSISTED LIVINGFACILITY NUMBER:
366413073
ADMINISTRATOR:SCHLOTTMAN, JACOBFACILITY TYPE:
740
ADDRESS:275 GARNET WAY BTELEPHONE:
(909) 204-5000
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:88CENSUS: 50DATE:
11/22/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ericka Montoya- Assistant AdministratorTIME COMPLETED:
11:29 AM
ALLEGATION(S):
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Staff are not following COVID guidelines and protocols.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility for the purpose of initiating an investigation and delivering findings for the above complaint allegation. LPA Gardner met with Assistant Administrator Ericka Montoya and explained the reason for the visit. At the time of the visit, there were fifty (50) residents present.

During today’s visit, LPA toured the facility, reviewed facility documents, interviewed staff members, and interviewed residents.

For allegation, Staff are not following COVID guidelines and protocols:

LPA found that the facility has a COVID-19 mitigation plan on file with State Licensing. The plan in place follows Community Care Licensing Division guidelines for COVID-19 testing, quarantining residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility has a full thirty (30) day supply of Personal Protective Equipment (PPE). All staff and visitors are given a mask to wear upon entry into the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
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-20221118090320
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: 11/22/2022
NARRATIVE
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Upon entry a temperature and symptom screening is completed for staff and residents. If a staff member has a temperature or symptoms, they are not allowed to enter the facility. The staff will be tested for COVID-19 and will be sent home to quarantine if they test positive. The facility staff monitors residents for COVID-19 symptoms. If a resident is experiencing symptoms and or tests positive for COVID-19, they are isolated in their bedroom. If there is a positive resident and or staff case in the facility, the facility completes a mass COVID-19 testing of all staff and residents.

Based on the information found during today’s investigation, the allegation listed above is deemed UNSUBSTANTIATED.

A finding that the complaint is UNSUBSTANTIATED means 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Assistant Administrator Ericka Montoya, along with a copy of the appeal rights.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2