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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900455
Report Date: 12/26/2024
Date Signed: 12/26/2024 10:10:46 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
12/20/2024 and conducted by Evaluator Sarina Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241220125755
FACILITY NAME:HERITAGE GARDENSFACILITY NUMBER:
360900455
ADMINISTRATOR:LEAK, LISAFACILITY TYPE:
740
ADDRESS:25271 BARTON RDTELEPHONE:
(909) 796-0219
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:64CENSUS: 54DATE:
12/26/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Jessica RamosTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not respond to resident's call button in a timely manner.
Staff did not follow resident's diet plan.
Staff did not allow resident use restroom.
Staff does not ensure facility is free of pests.
Staff did not ensure resident's bathroom is clean and sanitized.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Jessica Ramos, and discussed the purpose of the visit.

Regarding allegations above, The Administrator informed LPA that resident #1 (R1) never resided in the assisted living facility but resided in the skilled nursing facility. LPA obtained a resident roster from the skilled nursing facility that verifies R1 lived at the skilled nursing facility. Based on LPA's interviews and record review, the above allegation is Unfounded.

An Unfounded finding means, 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 of this report was provided to Administrator Jessica Ramos at the conclusion of the visit.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
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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