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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507005194
Report Date: 06/08/2023
Date Signed: 06/09/2023 10:19:06 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/30/2023 and conducted by Evaluator Kimberly Viarella
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230130135742
FACILITY NAME:HERITAGE HOMEFACILITY NUMBER:
507005194
ADMINISTRATOR:ROBERT L. IRWIN, JR.FACILITY TYPE:
740
ADDRESS:943 TERRACE COURTTELEPHONE:
(209) 845-2712
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:6CENSUS: 0DATE:
06/08/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mavis Irwin, LicenseeTIME COMPLETED:
11:00 PM
ALLEGATION(S):
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Staff did not address a resident's change in medical condition.

Staff left a resident soiled for extended periods of time while in care.

Staff did not properly position a resident while in care.

Staff not feeding resident an adequate amount of food.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 06/08/2023 by Licensing Program Analysts (LPAs) Kimberly Viarella and Charlie Yang who were met by the facility designated Administrator, Mavis Irwin.
Current census was 0 residents.
The purpose of this visit was to deliver the findings from this complaint investigation for the above allegations at this time.

Based on the information gathered through interviews, observations, and a review of records, it was learned that the residents in care at this facility were pleased with the care being provided. During the interviews, it was found that no one reported any concerns with the care and supervision at this time. Interviews revealed that residents actually gained weight at the facility because the food was found to be sufficient and able to meet the needs of the residents at this time. Interviews also revealed that multiple unannounced visits took place and there weren't any issues with hygiene or incontinence care for the residents at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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 27-AS-20230130135742
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: HERITAGE HOME
FACILITY NUMBER: 507005194
VISIT DATE: 06/08/2023
NARRATIVE
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As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited during today's complaint visit.

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2