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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413073
Report Date: 07/01/2021
Date Signed: 07/01/2021 03:51:17 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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2021 and conducted by Evaluator Natalie Gayoso
COMPLAINT CONTROL NUMBER: 18-AS-20210622160728
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: 59DATE:
07/01/2021
UNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Erika MontoyaTIME COMPLETED:
04:03 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are left in soiled diapers for a long period of time.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Natalie Gayoso and Anna Bueno conducted an unannounced visit to the facility to investigate the above allegations. LPAs met with Assistant Administrator Erika Montoya and explained the purpose of today's visit.

The investigation consisted of interviews with staff and residents. The allegation indicates residents are left in soiled diapers for a long period of time. Interviews Staff #1 (S1) and Staff #2 (S2) stated staff checks every 2 hours on residents who require diapers and have not been left in soiled diapers for a long period of time. Interviews with residents confirmed that staff checks on residents every 2 hours. Residents also stated they have not been left in soiled diapers for a long period of time. Resident #2 (R2), Resident #6(R6), Resident #7 (R7) stated they will also call caregivers for diaper change as needed and staff does assist in a timely manner.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Natalie Gayoso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
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 3
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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2021 and conducted by Evaluator Natalie Gayoso
COMPLAINT CONTROL NUMBER: 18-AS-20210622160728

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: 59DATE:
07/01/2021
UNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Erika MontoyaTIME COMPLETED:
04:03 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is without a nurse.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Natalie Gayoso and Anna Bueno conducted an unannounced visit to the facility to investigate the above allegations. LPAs met with Assistant Administrator Erika Montoya and explained the purpose of today's visit.

The allegation indicates facility is without a nurse. Interview with S1 stated the facility does not have residents that required nursing services at all times. The facility has a Licensed Vocational Nurse (LVN) that works from Sunday - Thursday from 9:30AM to 5:30PM and is on call 24 hours 7 days a week. If LVN assistance is needed, caregivers notify the Med-Tech who then calls the LVN.
This agency has investigated the complaint allegation. We have found that the complaint was Unfounded meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiences were cited during today's visit
An exit interview conducted and a copy of this report was provided to Ms. Montoya.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Natalie Gayoso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20210622160728
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HERITAGE COURT ASSISTED LIVING
FACILITY NUMBER: 366413073
VISIT DATE: 07/01/2021
NARRATIVE
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5
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8
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10
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21
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23
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25
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27
28
29
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31
32
Based on interviews the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were cited during this visit.
An exit interview was conducted, and a copy of this report was provided to the Ms. Montoya.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Natalie Gayoso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3