366413073-1-12-2023-18-AS-EMAN-CN9PKR-20230120102335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413073
Report Date: 01/12/2023
Date Signed: 01/12/2023 02:44:42 PM

Unfounded

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
01/11/2022 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220111102333

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:	02:48 PM

ALLEGATION(S):

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Resident is being overcharged.

INVESTIGATION FINDINGS:

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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 resident and staff interviews, and records review.

The allegation is Resident is being overcharged. Review of LIC602A, Physician's Report, LIC603, Preplacement Appraisal, and facility needs and service care plan show that Resident 1 (R1) requires medication management and assistance with self-care activities. LPAs reveiwed admissions agreement that shows R1 agreed to grooming and bathing services. LPAs reveiwed R1 payment history from 7/1/19 through 12/31/22 and found that bathing assistance and medication management were only charged on July 2019, August 2019, and October 2019. This allegation is therefore UNFOUNDED.

A finding of unfounded means that 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 Erika Montoya.

Unfounded

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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