366413073-1-12-2023-56-AS-EMAN-CNCQHC-20230123111054

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413073
Report Date: 01/12/2023
Date Signed: 01/12/2023 02:42:56 PM

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
01/03/2023 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230103105041

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: 48	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Erika Montoya - Assistant Administrator		TIME COMPLETED:	02:49 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff leave resident in bed for extended periods of time.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Anna Bueno and Michelle Echeverria conducted an unannounced visit to the facility to initiate the investigation of and deliver findings to the above mentioned allegation. LPAs identified themselves to assistant administrator Erika Montoya and discussed the purpose of the visit and elements of the allegation. The investigation included facility observations, resident and staff interviews, and records review.

It is alleged that Staff leave resident in bed for extended periods of time. Interviews with residents revealed that staff check on the residents regularly and residents use a call button for assistance. Records reviewed show that Resident 1 (R1) likes to be in bed most of the time. Interview with R1 confirmed they periodically go out to the community and that staff move them from their bed when requested. LPAs observed sufficient staff working with residents during today's visit. This allegation is therefore unsubstantiated.

A finding of 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. An exit interview was conducted with Erika Montoya and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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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