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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413073
Report Date: 08/26/2024
Date Signed: 08/26/2024 01:47:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
08/23/2024 and conducted by Evaluator Paola Guerrero
COMPLAINT CONTROL NUMBER: 56-AS-20240823115340
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: 45DATE:
08/26/2024
UNANNOUNCEDTIME BEGAN:
12:11 PM
MET WITH:Erika MontoyaTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not safeguard a resident's personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Erika Montoya and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First allegation, Staff did not safeguard a resident's personal belongings. Regarding the allegation “Staff did not safeguard resident’s personal belongings” LPA conducted a record review of Resident#1 file, during the review of records LPA discovered that an inventory sheet for R#1 was not on file and Administrator could not verify if R#1 inventory list was completed or filled out by resident/or residents’ representative. Due to missing document LPA could not verify Resident#1 personal belongings. LPA conducted an interview with Facility Administrator who indicated that all inventory sheets are completed upon admission. In addition, Administrator stated that facility does not follow-up with residents who have not completed a personal inventory list after the resident has been admitted to facility, making the facility unaware and not tracking residents’ personal property accordingly. Based on the evidence gathered during the investigation, the above allegations are Substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
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
Control Number 56-AS-20240823115340
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HERITAGE COURT ASSISTED LIVING
FACILITY NUMBER: 366413073
VISIT DATE: 08/26/2024
NARRATIVE
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Substantiated: A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, Theft and Loss 87218(a)(1)(2), from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided, along with a copy of the appeal rights to Facility Administrator Erika Montoya.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20240823115340
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HERITAGE COURT ASSISTED LIVING
FACILITY NUMBER: 366413073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2024
Section Cited
CCR
87218(a)(1)(2)
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Theft and Loss 87218.... (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153.... (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.... (2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153.
This requirement is not met as evidence by:
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Administrator has agreed to read over the Theft and Loss regulation and provide training to all support staff on how to properly record resident’s personal belongings. Administrator will provide a copy of training that is signed and dated by staff to LPA on POC date 9/20/2024.
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Based on interviews and record review, facility did not follow theft & loss regulation for Resident#1 leading to R#1 loss and mismanagement of R#1 personal belongings, which poses a potential health, safety, or Personal Rights risk to persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3